Precordial Catch Syndrome

Original Editor - Tess Mertens

Top Contributors - Rachael Lowe, Adu Omotoyosi Johnson, Ewa Jaraczewska and Tess Mertens  

Definition

Precordial catch syndrome (Texidor's Twinge) is a common but under-recognised cause of benign chest pain in children and adolescents, with unknown pathophysiology.

Epidemiology

The syndrome was first described by Henri Huchard in 1893 as 'précordialgie' and later studied by Miller and Texidor in 1955, leading to the alternate name 'Texidor's twinge'.

Precordial catch syndrome may occur at any age, but usually occurs in childrenand adolescents, typically from age 6 through early adulthood. There is no sex predilection. The pain usually occurs while the patient is at rest, but never occurs during sleep. It has no temporal correlation with meals. The underlying cause of this condition is unknown.

Despite being common, the condition remains under-recognised in clinical practice, leading to unnecessary anxiety and testing.

Clinical Presentation

The pain typically occurs when patients are at rest with poor posture, such as slouching, and episodes may be associated with periods of growth in adolescents . The pain is usually sudden and sharp, localising to one intercostal space along the left lower sternal border or to the cardiac apex, though the origin of the pain remains unknown . Episodes occur either at rest or during mild activity and are characteristically exacerbated with inspiration, which often leads to shallow breathing as patients attempt to alleviate the discomfort. The duration of episodes typically ranges from 30 seconds to 3 minutes, though they may occasionally resolve after just a breath or two, and rarely persist for up to 30 minutes. Importantly, there are no associated symptoms accompanying the pain, and physical examination findings are consistently normal

Differential Diagnosis

Several conditions must be considered in the differential diagnosis of precordial catch syndrome:

• Angina pectoris can occur in persons with congenital, inflammatory or atherosclerotic causes of coronary insufficiency, aortic valve stenosis and hypertrophic cardiomyopathy. This pain is rarely described as sharp, is not well localised, tends to begin and resolve insidiously and is provoked by exercise or activity.
• Mitral valve prolapse occasionally causes atypical chest pain, which may be sharp and well localised. However, this pain is not exacerbated with deep breaths and is accompanied by the click and murmur characteristic of this condition.
• The chest pain caused by pericarditis is associated with acute illness and is not transient, intermittent or well localised. 1
• Viral pleuritis or pleurodynia may produce sharp chest pain similar in character to precordial catch syndrome, but it is usually associated with fever and cough and is generally unrelenting.
• Chest wall syndrome and chest trauma, including rib fractures, can produce pain very similar to precordial catch syndrome. A history of trauma and localised tenderness of the chest wall are present.

Diagnostic Procedures

Diagnosis is primarily clinical based on characteristic history and physical examination. The classic pain history can help identify precordial catch syndrome, often eliminating the need for further testing or referrals.

While precordial catch syndrome is benign, certain features warrant further cardiovascular assessment:

• Chest pain occurring with exertion or exercise
• Associated symptoms such as syncope, palpitations, or shortness of breath
• Family history of sudden cardiac death or inherited cardiac conditions
• Systemic symptoms including fever, weight loss, or malaise
• Pain pattern that does not fit the typical characteristics of precordial catch syndrome
• Abnormal physical examination findings

Medical Management

The management of precordial catch syndrome is primarily supportive, emphasising patient and family education about the benign nature of the condition. Pharmacologic treatment is not indicated, given the rapid onset and offset of the pain.

Physical Therapy Management

Physical therapy management of precordial catch syndrome focuses on patient education and reassurance, as the condition is entirely benign and typically resolves without intervention.

• Primary reassurance: Emphasis is placed on the need for taking a careful history to elicit the diagnostic features of the syndrome and performing a thorough physical examination.
• Patient education: Explain the benign nature and expected resolution. Emphasise that the condition is not related to heart disease and poses no long-term health risks. Discuss the typical course and reassure patients and families that episodes will likely decrease with age.
• Breathing technique: Instruct patients to take a deep breath when pain occurs
• Posture guidance: Address poor posture as a potential contributing factor

Prognosis

Precordial catch syndrome has an excellent prognosis with complete resolution expected in most cases. The condition is entirely benign with no long-term complications or association with cardiac disease. Most patients experience fewer episodes as they age, with many outgrowing the condition by their third decade of life[1][9]. Episodes may occur once in a lifetime or recur periodically during childhood and adolescence, but the frequency typically decreases over time.