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

A 63-year-old man who had never smoked was seen in the outpatient clinic with complaints of exercise-induced dyspnea and a tightness in the upper chest when reaching maximal exercise. He had a medical history of a multinodular goiter, with tracheal compression resulting in a successful total thyroidectomy in November 2023. No spirometry was performed after thyroid surgery. There was no wheezing nor stridor present. The patient did not have any cough, sputum production, or fever. Mild gastroesophageal reflux complaints were also present. There was a mild irritation in the throat when swallowing. He performed regular physical activity, cycling 3 times per week. There was no relevant familial history. Before the current evaluation, the patient was diagnosed with asthma based on an elevated fractional exhaled nitric oxide and exercise-induced dyspnea, but without other typical symptoms of asthma. A treatment with inhaled corticosteroids/long-acting beta-agonists did not improve exercise-induced symptoms. Subsequently, the patient also underwent cardiologic evaluation (symptoms possibly resembling angina): a coronarography was performed, showing a mild stenosis of the left anterior descending artery with a fractional flow reserve of 0.75. Coronary artery disease was suspected, and a drug-eluding stent was placed, again without resolving the exercise-induced symptoms.