What is precordial catch syndrome?

Precordial Catch Syndrome (Texidor's Twinge)

Precordial catch syndrome (PCS) is a benign, non-cardiac cause of chest pain characterized by brief, sharp, well-localized discomfort that is typically intensified by inspiration and resolves spontaneously without treatment.

Definition and Classification

According to the American College of Cardiology/American Heart Association, precordial catch syndrome is classified as a form of musculoskeletal chest pain that is idiopathic in nature 1. It is also known as Texidor's twinge and represents a benign cause of chest pain in children and adolescents.

Clinical Characteristics

PCS has several distinctive features that aid in diagnosis:

• Pain characteristics:

  • Sudden onset, sharp, stabbing pain
  • Brief duration (seconds to minutes)
  • Periapical/precordial location (typically left side of chest)
  • Easily localized with fingertip to a specific intercostal space 2, 3
  • Non-radiating 2
  • Pain intensifies with inspiration 2, 4

• Timing and triggers:

  • Occurs at rest or during mild activity
  • Never occurs during exertion 5
  • Appears "out of the blue" without warning 5
  • Not associated with physical exertion or exercise 2

• Demographics:

  • Most common in children and adolescents
  • Affects both males and females 5
  • Often begins in adolescence 5
  • Can affect individuals of light or medium build 5

Diagnosis

Diagnosis of PCS is primarily clinical and based on the characteristic history. The American College of Cardiology/American Heart Association guidelines classify it as a form of musculoskeletal chest pain that is idiopathic in nature 1.

Key diagnostic steps include:

1. Detailed history focusing on the distinctive features of PCS (sudden onset, brief duration, localized pain that worsens with inspiration)
2. Physical examination to exclude other pathologic disorders
3. Recognition that PCS is not a diagnosis of exclusion - the characteristic symptoms are diagnostic 6, 4

Management

PCS is a benign condition that requires minimal intervention:

• Patient education and reassurance about the benign nature of the condition 5, 4
• Pain management strategies:
  • Taking a deep breath despite the pain may help terminate an episode 4
  • Changing position may provide relief
  • Shallow breathing until the pain subsides

Special Considerations

• PCS can occur in athletes, including elite swimmers, and may be associated with other conditions like asthma 6
• The condition can cause significant anxiety in children and parents if not properly diagnosed and explained 3
• Diagnostic testing is usually unnecessary when the history is classic for PCS 4

Differential Diagnosis

PCS should be distinguished from more serious causes of chest pain:

• Cardiac causes (myocardial ischemia, pericarditis)
• Pulmonary causes (pneumothorax, pleuritis)
• Other musculoskeletal causes (costochondritis, Tietze syndrome)
• Gastrointestinal causes (reflux, esophageal spasm)

The key distinguishing features of PCS are its brief duration, sharp localized nature, exacerbation with inspiration, and absence of other associated symptoms.

Prognosis

PCS has an excellent prognosis with no long-term sequelae. The episodes are self-limited and do not indicate underlying cardiac or pulmonary pathology. Reassurance about the benign nature of the condition is typically all that is needed for management.