Texidor’s Twinge

Epidemiology: PCS is most commonly reported in children and adolescents, particularly between the ages of 6 and 12 years, but may persist into adulthood. Males and females are equally affected. Estimates suggest it accounts for 80–90% of paediatric chest pain cases after excluding trauma. Despite its frequency, it remains under-recognised and is often misinterpreted as a cardiac condition, contributing to unnecessary anxiety and medical investigations.

Aetiology and Pathophysiology: The cause of PCS is unclear. The original authors proposed irritation of the parietal pleura or intercostal nerve entrapment as possible mechanisms. Other theories include minor chest wall muscle spasm, postural strain, or hypermobility of costal cartilage. PCS is not associated with underlying heart disease, and psychological overlay is minimal except as a result of misdiagnosis-induced anxiety.

Diagnosis is clinical, based on a characteristic history and absence of abnormal findings on examination. The pain is:

• Localised and sharp (“knife-like,” “piercing,” “catching”)
• Worse with inspiration
• Occurs at rest, particularly with slouched posture
• Resolves quickly with deep breath or postural correction

Investigations are not typically required unless features suggest alternative pathology. PCS is not a diagnosis of exclusion but rather a positively identifiable clinical entity.

Management: No medical therapy is necessary. Reassurance remains the cornerstone of management. Educating patients and families about the benign nature of the syndrome can alleviate anxiety and prevent over-investigation. Occasionally, addressing postural habits and stressors may help reduce recurrence.

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History of the Texidor Twinge

1892 – French physician Henri Huchard (1844-1910), renowned for his cardiological work, published early observations of benign, localised precordial pain in young, otherwise healthy individuals. He discussed these under the terms neurasthenic cardialgia and précordialgies (from the latin “praecordia” meaning “before the heart”), noting they were often transient, non-radiating, and unaccompanied by cardiac disease.

1955 – The Huchard syndrome of left-sided anterior chest pain in young healthy individuals was studied in greater detail by Albert J. Miller (1922-2020) and Teodoro Antonio Texidor (1913-1998). Working at the Michael Reese Hospital in Chicago they reviewed 10 patients aged 22 to 35; one of whom was Miller himself.

The pain has been variously described by different patients. The adjectives used include “knife-like,” “piercing,” “burning,” and “sharp.” All 10 of the patients stated the pain to be severe. Two of them suggested that “it is as if something catches,” and most of the other patients have agreed that this is an appropriate description.

The term “precordial catch” appears to be appropriate and makes no attempt to indicate the etiology of the pain.

Miller, Texidor 1955

1959 – Miller and Texidor further defined the condition with an additional 18 patients.

The pain is sharp, sudden in onset and severe, and is localized at or near the cardiac apex. It occurs at rest or during mild activity, and is often associated with a “bent over” or “slouched” posture. The immediate reaction to the pain is a suspension of breathing in mid-respiration or expiration. Subsequently, breathing usually is confined to shallow chest excursions. This eases the pain; attempts to take a deep inspiration aggravate it. Assuming a correct posture may ease it. A forced inspiration, in spite of the pain, may quickly relieve it

Miller, Texidor 1959

1959 – Richard Alan John Asher (1912-1969) first proposed the eponymous term following his Lettsomian lecture

As regards the name. Let doctors call it “precordial catch”. The name is admirable, and it does not imply any causal notions which might be refuted in a few years. It is short, descriptive, and effective…but so that the syndrome may be more widely known, some publicity is needed. Actors choose synonyms for this reason (stage names), and a memorable synonym, parenthetically subservient to the main title, will ensure the condition gets the recognition it needs. Call it Texidor’s Twinge, and its sale is guaranteed

Asher, 1959

1978 – Sparrow and Bird reported 45 healthy patients with the same form of benign chest pain and commented on its underappreciated frequency

2003 – Carl H. Gumbiner described precordial catch syndrome as a frequently encountered complaint in children which is underrecognized and commonly mistaken for other causes of pain

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

Gumbiner, 2003

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Associated Persons

• Henri Huchard (1844-1910)
• Albert J. Miller (1922-2020)
• Teodoro Antonio Texidor (1913-1998)

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Alternative names

• Précordialgie
• Syndrôme de Huchard, Huchard syndrome
• Precordial Catch Syndrome (PCS)
• Texidor’s Twinge

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Eponymic chest pain syndromes

• Bornholm disease
• Tietze syndrome
• Syndrôme de Huchard or Texidor Twinge
• Da Costa syndrome

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References

Historical references

• Huchard H. Les précordialgies. Revue générale de clinique et de thérapeutique 1893; 7: 1-2
• Chevillot P. Les précordialgies: étude séméiologique sur les douleurs de la région du coeur. 1893
• Millar AJ, Texidor TA. Precordial catch, a neglected syndrome of precordial pain. JAMA 1955; 159(14): 1364-1365.
• Millar AJ, Texidor TA. The “precordial catch,” a syndrome of anterior chest pain. Ann Intern Med. 1959; 51: 461-467.
• Asher R. Precordial catch (Texidor’s twinge). Lancet. 1959; 274(7105): 735

Eponymous term review

• Prinzmetal M, Massumi RA. The anterior chest wall syndrome: chest pain resembling pain of cardiac origin. J Am Med Assoc. 1955; 159(3): 177-184.
• Wehrmacher WH. The painful anterior chest wall syndromes. Med Clin North Am. 1958; 42(1): 111-118
• Sparrow MJ, Bird EL. “Precordial catch”: a benign syndrome of chest pain in young persons. N Z Med J. 1978 Oct 25;88(622):325-6
• Texidor’s twinge. Lancet. 1979 Jul 21;2(8134):133.
• Pickering D. Precordial catch syndrome. Arch Dis Child. 1981 May;56(5):401-3
• Selbst SM, Ruddy RM, Clark BJ, Henretig FM, Santulli T Jr. Pediatric chest pain: a prospective study. Pediatrics. 1988 Sep;82(3):319-23
• Reynolds JL. Precordial catch syndrome in children. South Med J. 1989 Oct;82(10):1228-30.
• Gumbiner C. Precordial Catch Syndrome. Southern Medical Journal. 2003;93(1):38-41