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A 63-Year-Old Man With Persistent Chest Constriction on Exercise.

Arne Coussement1, Pieter Goeminne2, Nico De Crem1

  • 1Department of Respiratory Diseases, University Hospitals Leuven, Belgium.

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Summary
This summary is machine-generated.

This case highlights a patient with persistent exercise-induced dyspnea despite asthma and coronary artery disease treatments. It underscores the importance of considering less common diagnoses when standard therapies fail.

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Area of Science:

  • Pulmonology
  • Cardiology
  • Endocrinology

Background:

  • A 63-year-old male non-smoker presented with exercise-induced dyspnea and chest tightness.
  • History of multinodular goiter treated with total thyroidectomy due to tracheal compression.

Observation:

  • Patient previously diagnosed with asthma based on elevated fractional exhaled nitric oxide (FeNO) and exercise-induced dyspnea.
  • Asthma treatment (inhaled corticosteroids/long-acting beta-agonists) provided no symptom relief.
  • Coronary angiography revealed mild left anterior descending artery stenosis (FFR 0.75), treated with a drug-eluting stent, also without symptom resolution.

Findings:

  • Persistent exercise-induced symptoms despite appropriate asthma and coronary artery disease management.
  • Absence of typical asthma symptoms like wheezing or stridor.
  • Underlying cause of exercise-induced dyspnea remains elusive after extensive workup.

Implications:

  • Suggests a potential need to explore alternative or rare etiologies for exercise-induced dyspnea.
  • Highlights diagnostic challenges in patients with multiple comorbidities and atypical presentations.
  • Emphasizes the importance of a comprehensive differential diagnosis beyond common conditions.