Abstract
The contribution of maximal exercise tests to the evaluation of 180 patients with chest pain associated with exercise (n = 147) or dyspnea on exertion (DOE, n = 33) was examined. The ages ranged from 5 to 22 (mean 13.2) years, and 68 patients were females. All patients had a normal cardiovascular examination, electrocardiogram, chest x-ray, and 2D-echocardiogram. Maximal exercise tests were performed on a treadmill or bicycle ergometer, and flow volume loops were performed before and after exercise (n = 65). Exercise tests did not reveal any cardiovascular abnormalities, but 14 patients with chest pain (9.5%) and seven patients with DOE (21.2%) developed exercise-induced asthma. Postexercise decrease in peak expiratory flow rate was 26.2 ± 3.7 percent in patients with chest pain and 39.4 ± 8.9 percent in those with DOE. Only five patients had a personal history and four others had a family history of asthma. Seven patients had a personal or family history of allergies. Implications: 1) exercise-induced asthma should be considered in pediatric patients with symptoms of chest pain or dyspnea on exertion; 2) when exercise tests are performed, flow volume loops should be included before and after exercise; 3) maximal exercise tests are unlikely to unmask any cardiovascular abnormalities in such patients.
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