What is precordial catch syndrome?

From the Guidelines

Precordial catch syndrome is a benign condition characterized by sharp, stabbing chest pain that typically occurs in children and young adults, and is not related to heart problems. This condition is also known as Texidor’s twinge or idiopathic precordial catch syndrome, as noted in the 2017 AHA/ACC key data elements and definitions for ambulatory electronic health records in pediatric and congenital cardiology 1. The pain is usually felt in a small, localized area on the left side of the chest and is often triggered by a change in posture, particularly when sitting or lying down.

Key Characteristics

• Episodes typically last from a few seconds to a few minutes and resolve spontaneously without treatment
• The exact cause remains unknown, but theories suggest it may involve a pinched nerve, muscle spasm, or brief irritation of the lining around the lung
• No specific treatment is necessary, though taking a deep breath may help relieve the pain, even though it might initially intensify it

Management

• Reassurance about the benign nature of this condition is usually the most important aspect of management, as many people worry they are experiencing a heart attack when these symptoms occur
• It is essential to differentiate precordial catch syndrome from other causes of chest pain, such as musculoskeletal chest pain due to costochondral junction syndrome (Tietze), costochondritis, or rib injury, as listed in the 2017 AHA/ACC report 1

Important Considerations

• Despite its alarming nature, precordial catch syndrome does not cause any long-term health issues
• The condition is not related to cardiac etiologies, such as angina pectoris or unstable angina, which are also discussed in the 2017 AHA/ACC report 1

From the Research

Definition and Characteristics of Precordial Catch Syndrome

• Precordial catch syndrome is a benign cause of chest pain in children and adolescents that remains underrecognized 2.
• The syndrome is characterized by sudden, brief, sharp, and severe precordial pain that occurs at variable intervals, often during rest or mild activity, and never on exertion 3.
• The pain is typically periapical, easily localized, nonradiating, and nonexertional, and is intensified by inspiration 4.

Diagnosis and Differential Diagnosis

• A detailed history eliciting diagnostic features is important, along with a physical examination excluding other pathologic disorders 2.
• The clinical judgment, a meticulous clinical history, and careful physical examination play a key role in the differential diagnosis of the precordial pain syndrome 5.
• Other characteristics of the ECG, such as T wave and ST segment alterations, bundle branch block (BBB), LV hypertrophy, interpretation discrepancies, can pose doubts or mistakes in the diagnosis 5.

Distinction from Other Conditions

• Precordial catch syndrome should be distinguished from other causes of chest pain, such as acute coronary syndrome, which can have a similar presentation 6.
• In patients with chronic Chagas disease, precordial chest pain can be a symptom of chronic Chagas heart disease, and should be evaluated and treated accordingly 6.

Importance of Recognition and Reassurance

• Recognition of the syndrome of precordial catch and reassurance of its benign nature will allay anxiety 3.
• A correct diagnosis and reassurance can help to avoid unnecessary tests and treatments, and can reduce the risk of misdiagnosis and mismanagement 2, 4, 3.