Hypertrophic Cardiomyopathy as an Unexpected Mimic of Inducible Laryngeal Obstruction: The Case for Cardiopulmonary Exercise Testing in Otolaryngology.

This is a single case report, so it cannot establish how often cardiac conditions mimic ILO in the general patient population. The patient was a competitive athlete, which may influence the presentation of cardiac symptoms and the baseline expectation for aerobic capacity. The authors note that resting ECG was not obtained prior to CPET due to high suspicion of airway pathology, suggesting that a simple pre-test screening step was missed. The diagnostic value of CPET with laryngoscopy is argued based on this one instance of a rare mimic, not on comparative effectiveness data.

Author B.M.W. reports no conflicts. Author N.K.L. has received modest consulting income from Myokardia Inc., Array BioPharma, and Sarepta Therapeutics. Author T.L.C. is a consultant for Pentax Medical, on the scientific advisory board, received royalties from Plural Publishing, and shares a patent and has shares in Sofregen Medical.

Do not assume that a diagnosis of inducible laryngeal obstruction based on resting laryngoscopy explains all exertional symptoms. In this case, the vocal folds did not obstruct during exercise; the symptoms were caused by atrial flutter. A failure to improve with standard ILO therapy should trigger investigation for cardiac causes, not just intensified laryngeal treatment.