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Treatment of Idiopathic Diaphragm Flutter: A Case Study

Michael Chiou, BA; María Victoria Herrero; John R. Bach, MD; Jeffrey L. Cole, MD; Enrique Luis Gonzales, AAS, CRT, RRT
Author and Funding Information

aDepartment of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ

bPetrona Villegas de Cordero Hospital, San Fernando, Buenos Aires, Argentina

CORRESPONDENCE TO: John R. Bach, MD, Department of Physical Medicine and Rehabilitation, University Hospital B-403, 150 Bergen St, Newark, NJ 07103


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(4):e69-e71. doi:10.1016/j.chest.2017.01.034
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Diaphragm flutter is a rare disorder defined by dyspnea and often thoracoabdominal pain associated with rapid rhythmic involuntary contractions of the diaphragm with no effective treatment. A 35-year-old woman’s flutter was triggered by increasing the depth of breathing and by (electrical) stimulation of the diaphragm. Medical therapy, phrenic nerve crush, and diaphragm pacer stimulation were ineffective. Since increasing diaphragm activity was a trigger, resting the diaphragm was tried. A manual resuscitator and, subsequently, mouthpiece and nasal noninvasive ventilatory support (NVS) instantaneously halted the flutter for 3 months and almost instantaneously for another 6 months. For 16 months, it has continued to halt flutter with rare episodes when getting out of bed that resolve with up to 40 minutes of NVS. To our knowledge, this is the first case of idiopathic diaphragmatic flutter for which diaphragm rest was used as successful treatment with no adverse effects. This should be tried for future cases.


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