Texidor’s Twinge

Also known as Precordial Catch Syndrome (PCS), Texidor Twinge is a benign condition that causes brief episodes of localised musculoskeletal chest pain in children and young adults


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’.

Dans une leçon clinique qu’il faisait à l’hopital Bichat au mois de novembre 1892, M. Huchard donnait le nom de précordialgie à toute douleur, accompagnée ou non d’angoisse, survenant dans la région précordiale. Après avoir passé en revue les diverses douleurs qui peuvent affecter cette région, notre excellent maître arrivait à cette conclusion: «En général, à de rares exceptions près, chaque fois qu’un malade vient se plaindre au médecin, d’une douleur dans la région cardiaque, il n’a pas d’affection organique du cœur»

Chevillot 1893

In a clinical lesson he gave at the Bichat hospital in November 1892, Mr. Huchard suggested the name precordialgia be given to any pain, whether accompanied by anxiety or not, occurring in the precordial region. After having reviewed the various pains which can affect this region, our excellent teacher came to this conclusion: “In general, with rare exceptions, each time a patient comes to complain to the doctor of a pain in the region of the heart, there is no organic cause

Chevillot 1893

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

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

2003Carl 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

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

References

Historical references

Eponymous term review


eponymictionary CTA

eponymictionary

the names behind the name

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a 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 |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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