Diaphragmatic Flutter Presenting as Inspiratory Stridor

Leeuwenhoek’s disease: diaphragmatic flutter in a cardiac patient

“…Phrenic nerve crush surgery has also been used to treat symptoms resistant to pharmacological therapy. 2,4 Psychological reassurance may afford relief of symptoms as occurred in our patient. In some instances this may be temporary and therefore periodic surveillance is required.…”

“…1 This entity remains rare with very few reported cases. [2][3][4][5] It is characterized by rapid rhythmic, involuntary contractions of the diaphragm. A rarer pattern of the disease also involving the respiratory muscles is termed respiratory myoclonus.…”

Treatment of Idiopathic Diaphragm Flutter

“…1,17,20 Phrenic nerve ablation surgery was reported to aid two of three patients for 6 and 12 months, respectively, with no further follow-up. 17,20 This case of idiopathic diaphragmatic flutter is the first, to our knowledge, to be successfully treated by resting the diaphragm long-term without adverse effects. Phrenic nerve ablation did not resolve her flutter and either caused or apparently exacerbated her pain.…”

“…Diaphragm flutter has been postulated to be caused by abnormal or increased excitation of the phrenic nerve associated with cardiomegaly, cervical disc herniation, cervical rib, lung disease, lymphadenitis, peritonitis, pleurisy, surgery, xiphoid fracture, psychogenic factors, 2,[7][8][9][10][11][12] and, as in this case, physiologically and electrically increasing demand on the diaphragm. Besides the failure of this patient's medical therapies, others have reported failure using carbamazepine, 3,8 chlordiazepoxide, 13 chlorpromazine, 14 clonazepam, 1,15,16 clonidine patches, 17 diazepam, 8 diphenylhydantoin, [17][18][19] fluoxetine, 1 gabapentin, 1 haloperidol, 17 pimozide, 17 phenobarbital, 8 phenytoin, 1,3,15 trimethadione, 19 triphenylhexidyl, 16 valproic acid, 17,19 carbon dioxide therapy, 13 CPAP, 14,19 and phrenic nerve block with bupivacaine. 1,17,20 Phrenic nerve ablation surgery was reported to aid two of three patients for 6 and 12 months, respectively, with no further follow-up.…”

"Thrombolysis" by a neuromuscular blocking agent

“…3). The echocardiogram performed subsequently showed diaphragmatic myoclonus at a frequency similar to the heart rate [1][2][3]. On the first electrocardiogram performed, the superimposed electromyographic activity of the diaphragmatic flutter was incidentally in phase with the QRS complex and had therefore been misinterpreted as cardiac electrical activity.…”