key: cord-0072002-bpzk9yrq
authors: Kravitz, Max S.; Dagan, Alon S.
title: Man With Hoarse Voice and Dyspnea on Exertion
date: 2021-12-20
journal: Ann Emerg Med
DOI: 10.1016/j.annemergmed.2021.07.109
sha: 233853c05b158f42a4100c87cc34a5b2ac50e608
doc_id: 72002
cord_uid: bpzk9yrq

nan

[Ann Emerg Med. 2022;79: 18.] A 39-year-old otherwise healthy man presented to the emergency department (ED) with a 2-month history of hoarse voice and progressive dyspnea on exertion. He reported a preceding flu-like illness with negative COVID-19 testing at the time. Physical examination was notable for a pulse rate of 113 beats/min and a hoarse voice. Bedside nasopharyngoscopy by the ED team demonstrated left vocal cord paresis (Figure 1 , Video E1 [available at http://www.annemergmed.com]). Chest radiography showed marked cardiomegaly (Figure 2 ). Laboratory studies were notable for a pro b-type natriuretic peptide of 2,444 pg/mL. The patient was admitted to the cardiology service with a diagnosis of acute systolic heart failure. Cardiac catheterization demonstrated severe global systolic dysfunction without angiographically apparent coronary artery disease. COVID-19 antibody testing returned positive.

For the diagnosis and teaching points, see page 30. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com. 

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