Abstract 2071
Exercise induced stridor as a cause of exercise related dyspnea is rare. We have evaluated six patients who developed severe, symptomatic inspiratory stridor during maximal cardiopulmonary stress testing. All had been referred for evaluation of exercise related dyspnea associated with syncope or near syncope. We determined the mechanism of stridor using fiberoptic laryngoscopy with video recording during exercise. Subject Characteristics: All were female competitive high school or college athletes (age range 15-20 years) with no known medical problems. All reported symptoms of abrupt onset of breathlessness and lightheadedness only with strenuous exercise, never at rest or with any other form of stress. Two had syncopal episodes while competing. All described a recurring problem, limiting sports participation. Initial Evaluation: All had normal physical exam, ECG, and baseline pulmonary function testing (PFTs), and then underwent a progressive, symptom-limited exercise stress test on a bicycle ergometer using James protocol. All exercised normally until abrupt onset of stridor at high work levels. All were threshold, at heart rates within 85% of predicted maximum. All had normal PFTs during recovery. Diagnostic Evaluation: All subjects were reevaluated 1 to 6 weeks following the initial study. All underwent rigid laryngoscopy and had normal laryngeal structures; and normal vocal cord motion with quiet respiration, phonation, and panting respiration. Four subjects underwent repeat exercise testing with a transnasal, fiberoptic laryngoscope with video recording, hand held for visualization of the larynx during exercise. All developed stridor due to abnormal anterior prolapse of the arytenoid region at peak exercise causing partial airway occlusion. This resolved quickly during recovery.
