Summary
Introduction
Inducible laryngeal obstruction is a common and challenging cause of exertional dyspnea.
We report a case of an unanticipated cardiac condition that presented with symptoms
suggestive of inducible laryngeal obstruction.
Discussion
A 55-year-old man was evaluated for progressive exertional dyspnea and throat tightness,
unexplained after multiple medical evaluations. Resting laryngeal examination was
suspicious for laryngopharyngeal reflux and mild vocal fold adduction during quiet
expiration. Given progressive and refractory symptoms, maximal cardiopulmonary exercise
testing with intermittent laryngeal examination was performed. This study excluded
laryngeal causes of exercise limitation and led to an unexpected diagnosis of persistent
atrial flutter and hypertrophic cardiomyopathy.
Conclusion
Cardiopulmonary exercise testing with laryngeal examination can identify unexpected
and life-threatening mimics of inducible laryngeal obstruction that may be missed
by unmonitored exercise challenges. Suspicion for inducible laryngeal obstruction
at rest may not predict the true nature of exercise limitation on cardiopulmonary
exercise testing.
Key Words
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Article info
Publication history
Published online: December 31, 2020
Footnotes
Funding: B.M.W.: NIH NHLBI 5T32HL007633-29 and 1K08HL151976.
Conflicts of Interest: B.M.W. reports no conflicts of interest. N.K.L. has received modest consulting income from Myokardia Inc., Array BioPharma, and Sarepta therapeutics. T.L.C is a consultant for Pentax Medical and is on the scientific advisory board, received royalties from Plural publishing and is on the scientific advisory board, and shares a patent and has shares in Sofregen Medical.
Identification
Copyright
© 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
