Children with chest pain have higher levels of anxiety and depression than children with an innocent heart murmur, an important factor for doctors to consider when diagnosing pediatric patients, according to a new study at the University of Georgia.

“The fact that these psychological symptoms are higher in non-cardiac chest pain patients suggests the psychological symptoms may be playing a role in the presentation of chest pain,” said Jennifer Lee, the lead author and a doctoral candidate in the University’s Franklin College of Arts and Sciences.

The study included 129 patients ages 8 to 18, who completed surveys while sitting in a cardiology office awaiting their unknown medical diagnosis.

Researchers found significantly more anxiety and depression in children who were later diagnosed with non-cardiac chest pain than those diagnosed with simple heart murmurs—the noise of blood flow in a structurally normal heart.

What is not clear is if the anxiety was a cause of the pain or if pain caused the anxiety.

“The higher levels weren’t so high as to cause a clinical diagnosis on their own, but when you contrast the two groups, there were statistically significant differences,” said study co-author Ronald Blount, a psychology professor at Franklin College.  “Psychology has a part in these symptoms and screening for psychological, as well as medical factors, is one implication we foresee coming from this investigation.”

Chest pain can often indicate a serious medical condition. In adults, it is often linked to a problem with the heart.  But in children, higher levels of anxiety are often reported, along with fears of experiencing physical symptoms that are related to a catastrophic health issue. Yet doctors say less than 2 percent of the children receive a cardiac diagnosis for their chest pain.

“We know up front that 99 percent of these patients will not have a heart complication at all. The trick is, it is not zero, and I cannot miss the one patient with heart disease because the consequences could be catastrophic,” said Dr. Robert Campbell, chief of the Sibley Heart Center and division director of the department of pediatrics at the Emory University School of Medicine.

Previous studies have shown reducing emotional symptoms can lead to better coping ability with pain. According to Campbell, an important outcome of the study is that it will help pediatricians correctly diagnose and counsel their patients.

“What we’ve learned is that after a physical evaluation of the patient, we take the time to sit down with the family and find out what they are most worried about so we can address their psychological issues,” Campbell said. “We’ve learned to pay attention and to be confident and reassuring. I need to make it clear to my patients and their parents that I’m not saying you are not having pain, but that the pain is not caused by your heart.”

The study also revealed that children with non-cardiac chest pain had a higher level of functional disability, such as the inability to participate in everyday activities like making it through a day without a nap or running across a football field.

They also spent less time at school and were less involved in extra-curricular activities.

“These kids also report greater levels of physical symptoms with unclear causes, like joint pain, stomach aches, headaches,” said Lee.  “These symptoms are believed to be psychological manifestations of stress. Sometimes your brain doesn’t tell you that you are stressed out, but your body does, so you will experience symptoms like these.”

The results of the study were published in the Journal of Pediatric Psychology.