Precordial Catch Syndrome


Precordial catch syndrome

Description, Causes and Risk Factors:

Abbreviation: PCS.

A benign syndrome of uncertain origin, characterized by sharp, sudden pain in the region of the cardiac apex on inspiration, yet usually relieved by forcing a deeper breath; tenderness is absent.

The precordial catch syndrome is an exceedingly common yet underrecognized cause of benign chest pain in children and adolescents. The syndrome has a remarkably consistent, characteristic presentation and is therefore easily diagnosed. Nonetheless, it frequently leads to elaborate testing and/or referral to a pediatric cardiologist and can be a source of considerable anxiety for many patients, their families, and their physicians.

The syndrome was first described and graphically termed precordial catch by Miller and Texidor. The painful sensation that constitutes the precordial catch syndrome is neither imaginary nor conversional. There is rarely a significant component of psychologic overlay or secondary gain (as may be seen in other chronic pain syndromes in children). The level of anxiety in the patient or parent may be raised if there has been a recent cardiac event in the family. The syndrome does not occur exclusively or more commonly in children of higher intelligence or socioeconomic status, but it is more readily recognized when the child can articulately describe the pain. The pathophysiology of the syndrome is unknown. The pain may originate in the parietal pleura, as suggested by Miller and Texidor, but it also resembles that of rib or cartilage injury, and so may stem from the chest wall. The pain is most certainly neither cardiac nor pericardial in origin.

The syndrome is so common, however, that it merits wider recognition by the medical community. Chest pain is a frequent complaint of children and adolescents. During a 9-week period, Driscoll et al 11 prospectively studied 43 pediatric clinic patients with that primary complaint. They identified six diagnostic categories of chest pain and concluded that it was common, usually benign, and rarely of cardiac origin. A number of subsequent studies and reviews drawn from outpatient, emergency, and cardiology settings have reported similar conclusions. Often, these studies tabulate the causes of the complaint in their series of patients, usually including precordial catch syndrome under a category of idiopathic, functional, or miscellaneous causes. The intent of most of these reports was to outline the differential diagnosis of chest pain and propose an appropriate diagnostic evaluation plan. Precordial catch syndrome is underemphasized relative to the frequency of its occurrence. Recently, Selbst studied and described a large number of pediatric patients with the primary complaint of chest pain. He emphasized the benign and noncardiac etiology of the chest pain and appropriately pointed out that laboratory testing is seldom helpful. He mentioned precordial catch syndrome among idiopathic causes and stated that it is rarely identified in patients presenting to the emergency department with complaints of chest pain.

Risk Factors:

Cardiac causes:

  • Angina pectoris.

  • Pericarditis.

  • Mitral valve prolapse.

  • Supraventricular tachycardia.

Pulmonary causes:

  • Pneumonia.

  • Asthma.

  • Pleurodynia.

  • Pneumothorax.

Gastrointestinal causes:

  • Gastritis.

  • Esophagitis.

Chest wall causes:

  • Trauma.

  • Muscle strain.

  • Inflammatory costochondritis.

  • Chest wall syndrome.

  • Slipping rib syndromea.

Other causes:

  • Sickle cell disease.

  • Substance abuse (cocaine).

Symptoms:

PCS has consistent characteristics. Its symptoms begin with a sudden onset of anterior chest pain on the left side of the chest. The pain is localized and does not radiate like heart attack pain typically does. Breathing in, and sometimes breathing out, often intensifies the pain. Typically this causes the patient to freeze in place and breathe shallowly until the episode passes. Episodes typically last a couple of seconds to three minutes. The frequency of episodes varies by patient, sometimes occurring daily, multiple episodes each day, or years between episodes. This is believed to be localized cramping of certain muscles groups. Intensity of pain can vary from a dull annoying pain to intense pain causing momentary vision loss/blurriness.

Although deep inhalation during a PCS attack will likely cause an increase in pain, many have found that forcing themselves to breathe as deeply as possible will result in a "popping" or "ripping" sensation which quickly and completely resolves the PCS episode.

PCS episodes happen most often while sitting or lying down, and being inactive.

Diagnosis:

Precordial catch syndrome has a remarkably characteristic and consistent presentation and therefore iseasily diagnosed.The pain is always described as sharp, stabbing, orneedlelike; it is well localized, and the patient canpoint to the painful area with one or two fingers.The diagnostic evaluation for precordial catch syndrome should consist almost exclusively of carefulhistory-taking and physical examination.Precordial catch syndrome is not a diagnosis of exclusion.

Treatment:

It is important to take time over details of the history and examination in order to be in a strong position from which to reassure the parent that there is either nothing clinically wrong, or that there is only a slight abnormality. It should be explained that the heart is the focus of attention, or has been for some time, and hence there is a tendency for chest pain to be focused at the heart. The probable site of the lesion is in the chest wall. Outside activities-such as the cubs, scouts, or ballet classes-should be encouraged to divert attention from the heart, rather than sitting indoors watching television. During puberty, in cases of bicuspid aortic valve when the gradient may change, non-invasive methods-such as echocardiography-should be used, with the Bennett formula. Discharge from a cardiac clinic or outpatient follow-up should be carried out if possible. One can always write to the family doctor asking him to refer the patient back if the pain changes in any way. Decreasing the frequency of outpatient visits is always a good boost to the patient's morale.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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