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Unlike other viscera or enlarging visceral masses of comparable size, progressive mechanical or volumetric stress typically fails to elicit persistent nociception; pain arises predominantly during acute events. Clinical and epidemiological observations show that many individuals with hypertrophied hearts can remain asymptomatic for decades, highlighting a paradox of silent cardiac enlargement. This suggests that cardiac sensory processing is not merely deficient but subject to selective gating. Integrating insights from cardiac mechanobiology, neurophysiology, and myocardial energetics, we propose the Cardiac Mechanoafferent Silencing Model (CMSM) as a conceptual gating framework, consistent with selective attenuation of chronic visceral nociceptive signaling while preserving sensitivity to acute ischemic and inflammatory threats. Furthermore, we outline anatomically and physiologically constrained buffering processes that may limit the emergence of other types of cardiac pain under physiological conditions. CMSM offers a testable conceptual framework to reconcile the dissociation between structural stress and perception, and to prioritize future experimental and translational investigations.<\/jats:p>","DOI":"10.1002\/cph4.70122","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:02:29Z","timestamp":1775019749000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mechanosensory Silence During Cardiac Stress"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2077-9188","authenticated-orcid":false,"given":"Duc Huy Hoang","family":"Nguyen","sequence":"first","affiliation":[{"name":"Pham Ngoc Thach University of Medicine  Ho Chi Minh City Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-386525-0.00035-4"},{"issue":"2","key":"e_1_2_12_3_1","first-page":"193","article-title":"Prevalence, Management and Outcomes of Cardiac Tamponade Complicating 66,812 Invasive Cardiac Procedures: Single\u2010Center Clinical Registry","volume":"17","author":"Adamczyk M.","year":"2021","journal-title":"Post\u0119py W Kardiologii Interwencyjnej Adv Interv Cardiol"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2012.05.070"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.5339\/qmj.2022.56"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcm.2022.09.007"},{"key":"e_1_2_12_7_1","unstructured":"American College of Cardiology. n.d.International Study of Comparative Health Effectiveness With Medical and Invasive Approaches."},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpain.2024.1346053"},{"key":"e_1_2_12_9_1","volume-title":"StatPearls","author":"Armstrong M.","year":"2023"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.14740\/cr1436"},{"key":"e_1_2_12_11_1","unstructured":"ArXiv. n.d.\u201c[1810.05451] The Importance of the Pericardium for Cardiac Biomechanics: From Physiology to Computational Modeling.\u201dhttps:\/\/arxiv.org\/abs\/1810.05451."},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-68639-2"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.2044-06.2006"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2001.00985.x"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v6.i1.80"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00424-008-0571-9"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318247cd03"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autneu.2024.103174"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.4330\/wjc.v12.i8.373"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000036600.39600.66"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00012.2005"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00350.2014"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0162416"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41392-024-01845-w"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2018.01058"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.545945"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/neu.20084"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2015.07.037"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-13-1756-9_9"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm13050786"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2011.12.042"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2024.105923"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms160921215"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-023-02894-y"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrn894"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(92)91250-8"},{"key":"e_1_2_12_37_1","first-page":"286","article-title":"Interactions Between Visceral Afferent Signaling and Stimulus Processing","volume":"9","author":"Critchley H. 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