Aim We aim to identify the diagnostic significance of ECGs and 24 h Holter monitoring in children with palpitations and chest pain.

Methods We retrospectively analysed all children presenting with palpitations and chest pain to the emergency department and to out-patient clinics between 2008–2013. Data was collected through detailed review of case-notes. ECGs and Holter results were classified as abnormal if a significant cardiac arrhythmia was identified. Isolated ectopic beats (ventricular or supraventricular) were not considered as abnormal.

Children with previously diagnosed heart conditions were excluded.

Results Palpitation was the predominant symptom 71% (n = 42) with remainder 29%(n = 17) presenting with chest pain. 8% (n = 5) were infants, 46%(27) were aged between 4–12 years and 46% (n = 27) were over 12-years. 20% (n = 12) presented to the emergency department, whilst 80%(n = 47) were referred from the general practitioners.

ECG was performed in 97% (n = 57) of cases during the initial assessment, of which 10% (n = 6) were noted to be abnormal. 86% (n = 49) of those who had ECGs underwent Holter monitor, of which, 18% (n = 9) were abnormal (the presenting history was palpitations in all these cases).

43% (n = 18) of the children with palpitations were diagnosed with a significant cardiac arrhythmia (12 with SVT, 3 with WPW, 3 with heart block). 57%(n = 24) were non-significant sinus tachycardia.

88% (n = 15) of children with chest pain were diagnosed to have non-cardiac cause. However, 12% (n = 2) were closely monitored due to a strong family history of cardiac arrhythmia.

Children with significant cardiac arrhythmias were referred to tertiary centre for further management.

Conclusion Palpitations and chest pain are not uncommon symptoms of presentation in the paediatric age group. The study demonstrates that ECGs are less sensitive compared to the 24-hour Holter, but in combination they are useful non-invasive diagnostic tools. Chest pain in children is probably of little concern as compared to palpitations and further investigations should only be requested if clinically indicated.