Shortness Of Breath - Triathlon

Abstract

HISTORY: A 50-year-old female triathlete with a history of hypertension and asthma was referred to our clinic for exercise-induced bronchoconstriction testing. She reported an 8 year history of episodes of dyspnea and cough that come on while competing in the swimming leg of the triathlon and continue through the rest of the race. Symptoms generally resolve within 24 hours. They do not occur with every race. They have never occurred during training. Onset of symptoms has never occurred during the bike or running leg. She was diagnosed with asthma 3 years prior and has been using albuterol prior to exercise as well as Advair as a controller agent since then, with no change in frequency of episodes. PHYSICAL EXAMINATION: Well-appearing, no acute distress. Neck without carotid bruits. Lungs clear bilaterally, no wheezes, rales, or rhonchi. CV normal S1 and S2, regular, with no murmurs, rubs, or gallops. No peripheral edema. Peripheral pulses 2+ DIFFERENTIAL DIAGNOSIS:Swimming-induced pulmonary edema, asthma, exercise-induced bronchoconstriction, vocal cord dysfunction, cardiogenic pulmonary edema, coronary artery disease TEST AND RESULTS: Spirometry pre- and post-exercise were performed with no evidence of obstructive lung disease and no decrease in FEV1 post-exercise. Exercise stress echo was also performed, which showed normal cardiac function and no evidence of exercise-induced ischemia. The patient had a markedly hypertensive response to exercise. Post-exercise PA systolic pressure was estimated at 65–75 mm Hg. FINAL WORKING DIAGNOSIS: Swimming-induced pulmonary edema in the setting of hypertension TREATMENT AND OUTCOMES: The patient was evaluated by cardiology. Hypertension was treated. She had not experienced any symptoms during her last few races.