A case of vocal cord dysfunction with Takotsubo cardiomyopathy: is there a link?

Vocal cord dysfunction (VCD) is an underrecognised cause of dyspnoea as it is seldom life threatening, and also difficult to diagnose. However, there have been rare accounts of VCD, as in the present case, which have led to haemodynamic instability. This patient with VCD episodically developed acute pulmonary oedema, bilateral pleural effusions and Takotsubo cardiomyopathy, treated effectively with tracheostomy. This presentation hints at the possible existence of a common pathophysiological mechanism, namely, forced inspiration against a closed airway or sympathetic overstimulation.

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Acute pulmonary oedema complicating laryngospasm

The Journal of Laryngology & Otology ◽

10.1017/s0022215100137703 ◽

1997 ◽

Vol 111 (5) ◽

pp. 482-484 ◽

Cited By ~ 4

Author(s):

Duncan Ingrams ◽

Martin Burton ◽

Alison Goodwin ◽

John Graham

Keyword(s):

Pulmonary Oedema ◽

Acute Pulmonary Oedema ◽

Pathophysiological Mechanism ◽

Laryngeal Spasm ◽

Important Complication

AbstractPulmonary oedema is an uncommon but important complication of laryngeal spasm which in turn occurs more commonly in ENT practice than in most other surgical specialities. A case is reported and the literature reviewed, with particular reference to the proposed pathophysiological mechanism of this phenomenon.

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Incidence, mechanisms and impact outcome of hyperglycaemia in severe scorpion-envenomed patients

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018818772779 ◽

2018 ◽

Vol 9 (7) ◽

pp. 199-208 ◽

Cited By ~ 3

Author(s):

Mabrouk Bahloul ◽

Olfa Turki ◽

Anis Chaari ◽

Mounir Bouaziz

Keyword(s):

Emergency Department ◽

Pulmonary Oedema ◽

Clinical Manifestations ◽

Vital Signs ◽

Haemodynamic Instability ◽

Scorpion Envenomation ◽

Icu Length Of Stay ◽

Life Threatening ◽

Initiation Of Therapy ◽

Scorpion Stings

Hyperglycaemia is often observed in severe scorpion-envenomed patients. It is due to a severe autonomic storm with a massive release of catecholamines, increased glucagon levels, cortisol levels, and either decreased insulin levels or insulin resistance. The presence of hyperglycaemia is an indicator of severity in this specific condition. Indeed, hyperglycaemia was associated with the severity of clinical manifestations of severe scorpion envenomation requiring intensive care unit (ICU) admission. In fact, the presence of hyperglycaemia was associated with the presence of respiratory failure, pulmonary oedema, haemodynamic instability, neurological failure, multisystem organ failure, and an increased mortality and ICU length of stay. As a consequence, we think the presence of hyperglycaemia in scorpion-envenomed patients at the emergency department prompts searching for presence of systemic manifestations or cardiorespiratory manifestations. As a consequence, the presence of hyperglycaemia can help screen severe patients at the emergency department. The current management of severe scorpion envenomation involves the admission and close surveillance in the ICU, where vital signs and continuous monitoring enable early initiation of therapy for life-threatening complications. The use of antivenom for scorpion stings remains controversial. All patients with pulmonary oedema should receive prazosin and possibly dobutamine, according the scorpion’s species. Mechanical ventilation is usually used in severe cases. Insulin should be reserved for severe cases with confirmed excessive hyperglycaemia (>10 mmol/l).

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Asthma mimic: Case report and literature review of vocal cord nodule associated with wheezing

SAGE Open Medical Case Reports ◽

10.1177/2050313x17744980 ◽

2017 ◽

Vol 5 ◽

pp. 2050313X1774498

Author(s):

Muhammad Kashif ◽

Tushi Singh ◽

Ahsan Aslam ◽

Misbahuddin Khaja

Keyword(s):

Vocal Cord ◽

Upper Airway ◽

Vocal Cord Dysfunction ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Diffuse Panbronchiolitis ◽

Reactive Airway Dysfunction Syndrome ◽

Retrosternal Goiter ◽

Life Threatening ◽

Clinical Conditions

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. Various clinical conditions can mimic asthma, such as foreign body aspiration, subglottic stenosis, congestive heart failure, diffuse panbronchiolitis, aortic arch anomalies, reactive airway dysfunction syndrome, chronic obstructive pulmonary disease, retrosternal goiter, vocal cord tumors, other airway tumors, and vocal cord dysfunction. Upper airway obstruction can be a life-threatening emergency. Here, we present the case of a 58-year-old female with recurrent hospital visits for wheezing and exacerbations of asthma, who was later found to have a vocal cord nodule confirmed to be squamous cell carcinoma, which was mimicking like asthma.

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A life-threatening case of pseudo-aldosteronism secondary to excessive liquorice ingestion

BMC Endocrine Disorders ◽

10.1186/s12902-021-00816-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Joseph McHugh ◽

Ramesh Nagabathula ◽

Ma Pyeh Kyithar

Keyword(s):

Pulmonary Oedema ◽

Dietary Habits ◽

Road Traffic ◽

Serum Magnesium ◽

Hypertensive Crisis ◽

Acute Pulmonary Oedema ◽

Potential Health ◽

Urinary Potassium ◽

Apparent Mineralocorticoid Excess ◽

Life Threatening

Abstract Background Liquorice is found in many food products, soft drinks, and herbal medicines. Liquorice ingestion is an uncommon cause of apparent mineralocorticoid excess or pseudo-aldosteronism. The mechanism involves the inhibition of 11-beta-hydroxysteroid dehydrogenase type-2 by the active ingredient called glycyrrhizin. This leads to the uninhibited activation of mineralocorticoid receptors by cortisol. Confectionary products that contain liquorice are readily available in many countries around the world. Case presentation We report a case of severe refractory hypokalaemia with hypertensive crisis and acute pulmonary oedema due to excessive liquorice consumption. A 79-year-old female presented to the emergency department following a road traffic accident. She described feeling weak and dizzy while driving before the collision. She attended her general practitioner (GP) several weeks earlier for fatigue and was being managed for hypokalaemia on oral potassium supplements. Investigations revealed hypertension (BP 180/69 mmHg), severe hypokalaemia (K 2.2 mmol/l), normal renal function, normal serum magnesium with metabolic alkalosis. Spot urinary potassium was 22 mmol/l. The patient denied taking medications including over-the-counter or herbal medication that can cause hypokalaemia. Hypokalaemia persisted despite aggressive intravenous (i.v.) and oral potassium replacement. She later developed a hypertensive crisis (BP 239/114 mmHg) with pulmonary oedema. She required admission to the intensive care unit and was managed with intravenous furosemide infusion and isosorbide dinitrate infusion. On further discussion, our patient admitted to struggling with nicotine cravings since quitting smoking two months earlier. She began eating an excessive amount of liquorice sweets to manage her cravings. Suppression of plasma renin and aldosterone supported the diagnosis of apparent mineralocorticoid excess secondary to excessive liquorice consumption. Her symptoms and hypokalaemia resolved after stopping liquorice intake. Conclusions This case highlights the life-threatening and refractory nature of hypokalaemia secondary to excessive liquorice consumption. This case also emphasizes the importance of comprehensive history taking including dietary habits. Increased awareness among the public is required regarding the potential health hazards of excessive liquorice consumption.

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Familial Vocal Cord Dysfunction

PEDIATRICS ◽

10.1542/peds.76.5.750 ◽

1985 ◽

Vol 76 (5) ◽

pp. 750-753

Author(s):

Michael J. Cunningham ◽

Roland D. Eavey ◽

Daniel C. Shannon

Keyword(s):

Pulmonary Function ◽

Vocal Cord ◽

Vocal Cord Paralysis ◽

Pulmonary Function Tests ◽

Endoscopic Examination ◽

Spontaneous Resolution ◽

Vocal Cord Dysfunction ◽

Common Cause ◽

Function Tests ◽

Life Threatening

Vocal cord paralysis is a common cause of neonatal stridor. Familial vocal cord dysfunction, however, is unusual. All three siblings in one family had neonatal stridor. Vocal cord dysfunction was confirmed after endoscopic examination in two of the children; a temporary tracheotomy was required by one child. Results of evaluation, including pulmonary function tests, suggest discrete dysfunction localized to the neuromuscular pathway responsible for vocal cord abduction. Endoscopy is of prime importance in the diagnosis of vocal cord dysfunction. In considering therapy, the physician must weigh both the potentially life-threatening nature of vocal cord paralysis, as well as the likelihood of eventual spontaneous resolution of many familial and idiopathic cases.

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Vocal Cord Dysfunction Patients Are High Users of Health Care

Internal Medicine News ◽

10.1016/s1097-8690(05)71602-4 ◽

2005 ◽

Vol 38 (4) ◽

pp. 28

Author(s):

DOUG BRUNK

Keyword(s):

Health Care ◽

Vocal Cord ◽

Vocal Cord Dysfunction

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Vocal Cord Dysfunction Can Mimic Asthma

Clinical Psychiatry News ◽

10.1016/s0270-6644(11)70150-3 ◽

2011 ◽

Vol 39 (4) ◽

pp. 31

Author(s):

M. ALEXANDER OTTO

Keyword(s):

Vocal Cord ◽

Vocal Cord Dysfunction

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Life-threatening Takotsubo Cardiomyopathy

The American Heart Hospital Journal ◽

10.15420/ahhj.2011.9.2.119 ◽

2011 ◽

Vol 9 (2) ◽

pp. 119 ◽

Cited By ~ 4

Author(s):

Karen Mrejen-Shakin ◽

Ricardo Lopez ◽

Mohandas M Shenoy ◽

◽

...

Keyword(s):

Heart Failure ◽

Left Ventricle ◽

Acute Heart Failure ◽

Takotsubo Cardiomyopathy ◽

Stress Test ◽

Systolic Dysfunction ◽

Apical Ballooning ◽

Assisted Ventilation ◽

Two Dimensional ◽

Life Threatening

Objective:To report a case of seizure-induced takotsubo cardiomyopathy with rare etiology and rarer complications.Methods:A 50-year-old woman had multiple epileptic seizures and later developed acute heart failure complicated by ventricular fibrillation and shock. A two-dimensional echocardiogram revealed apical ballooning of the left ventricle resembling a takotsubo (a Japanese fisherman's pot used to trap octopi). The apex was also hypokinetic.Results:The hemodynamic abnormalities normalized with defibrillation, assisted ventilation, inotropic support, and pressor agents. More importantly, the apical ballooning deformity and systolic dysfunction reversed. The echocardiogram normalized three months later. A nuclear treadmill stress test was negative for ischemia.Conclusions:Apical ballooning of the left ventricle and hypokinesis are typical echocardiographic features in takotsubo cardiomyopathy, a stress-induced heart disease. It may follow severe emotional, physical, and neurologic stressors, in our rare case, grand mal seizures (0.2 % of all takotsubo disease patients). Also rare are life-threatening complications. Based on these observations, in a case with severe stress followed by acute heart failure, takotsubo cardiomyopathy should be a major diagnostic consideration. The dramatic initial triggering event, in our case an epileptic seizure, should not mask the possibility of coexisting takotsubo cardiomyopathy. Awareness of this disease, anticipation of complications, and two-dimensional echocardiography will help channel the management in the right direction.

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