Texidor’s Twinge

Clinical presentation

• Episodes last seconds to minutes and can be localised with the fingertip to one intercostal space at the left sternal border or cardiac apex (although pain is not reproducible)
• Pain is pleuritic, non-exertional, and typically sudden onset at rest or with minimal activity
• Forced inspiration or correction of posture often relieves pain completely
• Aetiology is unknown

History of the Texidor Twinge

1892 – First described by the French cardiologist Henri Huchard (1844-1910). Huchard termed the condition ‘précordialgie’ (from the latin “praecordia” meaning “before the heart”), and it was later termed ‘Syndrôme de Huchard’ of ‘Huchard syndrome’.

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 Asher 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

Associated Persons

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

Alternative names

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

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

Thomas Morey

Emergency medicine RMO at Sir Charles Gairdner Hospital with a keen interest in cardiorespiratory medicine, intensive care and anaesthetics. MBBS, GKT School of medicine. BSc in Biomedical engineering and material science, Barts & The London.

Mike Cadogan

Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |