Association between Upper Thoracic Spine Findings and Cardiac-Related Functional Symptoms: A Pilot Observational Study

Abstract

Background : Cardiovascular disease remains a leading cause of mortality worldwide. In parallel with established cardiovascular risk factors, there is continuing interest in whether neuromusculoskeletal and autonomic mechanisms may contribute to cardiac-related symptom perception or regulation. The upper thoracic spine is anatomically relevant to sympathetic pathways connected to the heart, but clinical evidence linking upper thoracic findings with cardiac-related symptoms remains limited. Objective: To explore whether palpation-based upper thoracic spine findings at T1-T5 are associated with cardiac-related functional symptoms in a pilot observational clinical sample. Methods: This pilot observational study included 100 patients assessed in a clinical teaching setting. T1-T5 irregularity was defined as any palpation-based upper thoracic finding at one or more segments from T1 to T5, including asymmetry, deviation, or reduced/restricted segmental mobility. Symptom status was defined as the presence or absence of cardiac-related symptoms at the time of assessment, including palpitations, chest discomfort or tightness, irregular heartbeat, shortness of breath, or suspected arrhythmia. Traditional Chinese medicine pulse assessment and conventional cardiac records, when available, were used descriptively. The primary analysis examined the association between T1-T5 irregularity and symptom status using the chi-square test. Results: Of 100 patients, 80 had cardiac-related symptoms and 20 did not. T1-T5 irregularity was identified in 80 patients and was absent in 20. Among patients with T1-T5 irregularity, 68/80 (85%) had symptoms, compared with 12/20 (60%) among those without such findings. Chi-square analysis showed a statistically significant association between T1-T5 irregularity and cardiac-related symptoms (χZ = 6.67, p = 0.0098), with a small-to-moderate effect size (Cramér’s V = 0.26). Exploratory notes in the clinical records suggested that greater perceived spinal abnormality and greater symptom burden may co-occur in some cases, but the source records did not preserve a validated severity scoring system; therefore, no formal severity inference is presented. Conclusions: In this pilot observational sample, palpation-based upper thoracic findings were associated with cardiac-related functional symptoms. These results are hypothesis-generating and do not establish causation. More rigorous controlled studies using standardized spinal assessment, complete cardiac testing, and adjustment for confounders are required.