Professor

Cardiovascular disease remains a major global health burden and continues to account for a substantial proportion of deaths worldwide. According to the World Health Organization, cardiovascular diseases account for approximately one-third of global mortality, and heart disease remains a leading cause of death in the United States according to the Centers for Disease Control and Prevention.1,2 Established contributors such as hypertension, dyslipidemia, diabetes, smoking, obesity, and genetic predisposition remain central to cardiovascular risk assessment. However, increasing attention has also been directed toward autonomic regulation, somatic-visceral interactions, and the possibility that some cardiac-related symptoms may overlap with or be influenced by neuromusculoskeletal processes.3-5 The upper thoracic spine is anatomically relevant to cardiac autonomic control because sympathetic preganglionic neurons associated with cardiac innervation arise from upper thoracic spinal segments, with subsequent integration at the paravertebral and cardiac plexus levels.6,7 This anatomical relationship has contributed to longstanding interest in whether altered thoracic biomechanics, segmental dysfunction, or somatic afferent input might influence autonomic output, visceral sensation, or symptom perception. Experimental and clinical studies have suggested that spinal stimulation or manipulation may produce short-term autonomic responses, although the evidence is heterogeneous and methodologically limited.4,5,8-10 Recent systematic review evidence has further emphasized that claims regarding spinal influences on the autonomic nervous system should be interpreted cautiously because the overall quality of evidence remains low.11 At the same time, chest discomfort, palpitations, dyspnea, and related symptoms do not always arise solely from primary cardiac pathology. Musculoskeletal disorders of the chest wall, cervical spine, and thoracic spine may produce or amplify symptoms that overlap with cardiopulmonary complaints, thereby complicating clinical interpretation.12 Such overlap is clinically important because symptom similarity does not imply shared pathophysiology, yet it may influence diagnostic reasoning and patient distress. Within this context, the present pilot observational study explored whether upper thoracic spine findings at T1-T5 were associated with cardiac-related functional symptoms in a clinical teaching setting. The study was designed as an initial, hypothesis-generating investigation rather than a definitive etiologic or diagnostic study. The primary aim was to examine whether the presence of palpation-based T1-T5 irregularity was associated with the presence of cardiac-related symptoms. A secondary exploratory aim was to consider whether more pronounced clinical thoracic findings might coincide with greater symptom burden, while recognizing that the source records did not preserve a validated severity scoring rubric.