What is the cause of Precordial Catch Syndrome (PCS)?

Precordial Catch Syndrome: Etiology and Understanding

Precordial Catch Syndrome (PCS) is a benign condition with no identified pathological cause, characterized by brief episodes of sharp, localized chest pain that is non-cardiac in origin. 1

Clinical Characteristics

• PCS typically presents as sudden, brief, sharp pain that is easily localized to a specific point in the precordial region (usually over an intercostal space) 2, 3
• The pain is characteristically intensified by inspiration, non-radiating, and non-exertional 2
• Episodes occur "out of the blue," typically during rest or mild activity, and never during exertion 4
• The pain is usually self-limiting and resolves spontaneously within seconds to minutes 1
• Most commonly affects adolescents and young adults, with onset typically during adolescence 4

Distinguishing Features from Cardiac Causes

• Unlike cardiac pain, PCS is not associated with exertion 4
• The localized nature of the pain (patient can point to it with a fingertip) differs from the diffuse nature of cardiac pain 3
• The brief duration and spontaneous resolution without intervention distinguish it from more serious conditions 1
• The pain intensifies with inspiration, which is not characteristic of cardiac pain 2

Relationship to Other Conditions

• PCS has been reported in elite swimmers with asthma, suggesting possible association with respiratory conditions in some cases 5
• Most affected individuals are otherwise healthy, of light to medium build, and non-smokers 4
• Unlike musculoskeletal chest pain mentioned in pediatric guidelines, PCS is not the typical pediatric chest pain that represents musculoskeletal pain 6
• PCS should be distinguished from atypical chest pain that might raise alarm for underlying cardiac causes 6

Diagnostic Approach

• Diagnosis is primarily clinical, based on the distinctive pattern of symptoms 1
• A detailed history eliciting the characteristic features is essential for diagnosis 5
• Physical examination should be performed to exclude other pathologic disorders, but is typically normal in PCS 5
• Diagnostic testing is usually unnecessary when the clinical presentation is classic for PCS 1

Management

• Reassurance about the benign nature of the condition is the primary intervention 4
• Educating patients that this is a recognized syndrome can significantly reduce anxiety 3
• Some patients find relief by taking a deep breath or changing position during an episode 1
• No specific medical treatment is required for this condition 1

Clinical Pitfalls

• PCS remains underrecognized despite being extremely common 1
• Failure to recognize PCS can lead to unnecessary anxiety and medical investigations 4
• PCS should not be confused with more serious causes of chest pain that require further evaluation 5
• While PCS is benign, it's important to ensure other causes of chest pain are appropriately excluded through careful history and physical examination 5