Cardiovascular functional disorder and distress among patients with thoracic outlet syndrome

Cardiovascular functional stability of 11 women with thoracic outlet syndrome (TOS; mean age 34.5) and nine female controls (mean age 35.1) was studied using an orthostatic test, a deep breathing test, Valsalva manoeuvre and hand-grip test. The heart rate at rest was significantly higher in TOS patients. The TOS group showed significant accentuation in T wave vacillation in the orthostatic test. The rise in diastolic blood pressure of the TOS group during a hand-grip test was significantly less than that of the control group. TOS patients experienced significantly more distress according to the modified somatic perception questionnaire (MSPQ) than the control group. Pain was correlated with the score of MSPQ, the resting heart rate and increase in diastolic blood pressure in a hand-grip test. The results suggest that TOS patients' symptoms often reflect a wider disturbance than merely anatomical compression in the thoracic outlet. It seems possible that sympathetic tone is higher in TOS patients than in controls. In addition to possible operative treatment, it may be necessary to provide psychological help, relaxation and endurance training.