Heart failure with reduced ejection fraction — MCCQE Part 1 MCQ

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ModerateDyspneaHeart failure with reduced ejection fractionMCCQE Part 1

Three months after prolonged intubation, a patient develops progressive exertional dyspnea and biphasic stridor. Spirometry shows flattening of both inspiratory and expiratory limbs. What is the best next step?

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Correct answer: D — Arrange urgent specialist airway endoscopy

Biphasic stridor and flattening of both limbs of the flow-volume loop indicate fixed central upper-airway obstruction. After prolonged intubation, post-intubation subglottic or tracheal stenosis is likely. Obtain urgent otolaryngology or interventional-respirology assessment with flexible or rigid endoscopy and cross-sectional imaging for anatomy and procedural planning. Treatment may include endoscopic dilation, scar incision, stenting in selected cases, or segmental resection and reconstruction. Asthma therapy, antibiotics and anticoagulation do not relieve a fixed stenosis. Rapidly worsening stridor or respiratory fatigue requires emergency airway planning.

Reference: NIH Subglottic Stenosis review: https://www.ncbi.nlm.nih.gov/books/NBK564393/