What is Precordial Catch Syndrome?

Precordial Catch Syndrome

Precordial catch syndrome is a benign condition characterized by brief, sharp, well-localized chest pain that intensifies with inspiration and resolves spontaneously without treatment. 1

Clinical Features

Precordial catch syndrome (PCS) has several distinctive characteristics that make it recognizable:

• Sudden onset - Pain appears "out of the blue" without warning
• Sharp, stabbing pain - Often described as feeling like a "catch" or "stitch"
• Brief duration - Typically lasting seconds to minutes (rarely longer)
• Well-localized pain - Patients can point to the exact spot with a fingertip
• Periapical/precordial location - Usually left-sided chest pain
• Pain intensifies with inspiration - This is a hallmark feature
• Non-exertional - Occurs during rest or mild activity, never during exercise
• Non-radiating - Pain stays in one location
• No associated symptoms - No shortness of breath, diaphoresis, or other concerning features

1, 2, 3

Demographics and Prevalence

• Most common in children and adolescents
• Affects both males and females
• Often begins in adolescence
• More common in individuals of light or medium build
• Can occasionally occur in elite athletes, including those with asthma 4

Diagnosis

Diagnosis is primarily clinical and based on the characteristic presentation. PCS is not necessarily a diagnosis of exclusion when the classic features are present 4. Key diagnostic elements include:

1. Characteristic sharp, well-localized pain
2. Pain that worsens with inspiration
3. Brief duration with spontaneous resolution
4. Normal physical examination
5. No concerning features suggesting cardiac or pulmonary pathology

Management

The American College of Cardiology/American Heart Association recommends:

1. Patient education and reassurance about the benign nature of the condition
2. Pain management strategies:
   • Taking a deep breath despite the pain (may help resolve it faster)
   • Changing position or posture
   • Shallow breathing until the pain subsides

No specific medications or interventions are typically required. 1

Prognosis

PCS has an excellent prognosis with no long-term sequelae. The condition may recur periodically but does not lead to any complications or chronic issues. Reassurance about the benign nature of the condition is typically all that is needed. 1, 3

Differential Diagnosis

It's important to distinguish PCS from more serious causes of chest pain:

• Cardiac causes: Angina, myocardial infarction, pericarditis
• Pulmonary causes: Pneumothorax, pulmonary embolism, pleurisy
• Musculoskeletal causes: Costochondritis, Tietze syndrome, rib fracture
• Gastrointestinal causes: GERD, esophageal spasm
• Neurological causes: Thoracic spine pathology (rare but can present similarly) 5

Clinical Pearls

• The ability to localize the pain to a specific intercostal space with a fingertip is a particularly helpful diagnostic feature 6
• PCS never occurs during exertion, which helps distinguish it from cardiac causes 3
• Reassurance is crucial as the pain can be quite severe and alarming to patients and parents
• No further diagnostic workup is needed when the presentation is classic

Understanding and recognizing this syndrome can prevent unnecessary anxiety, emergency department visits, and diagnostic testing in affected individuals.