Flutter of the Diaphragm refers to a symptom characterized by paroxysmal or persistent spasms of the diaphragm, accompanied by sudden closure of the glottis during inhalation, producing a short and peculiar sound that is uncontrollable. Based on the severity of the spasms, it is classified into hiccup (Hiccup), phrenospasm (Phrenospasm), and flutter of the diaphragm. Diaphragmatic flutter is rare, and when it occurs, the diaphragm contracts extremely rapidly and rhythmically, reaching 100 to 300 times per minute.

bubble_chart Etiology

This condition can be caused by local involvement of the phrenic nerve, stimulation of the vagus nerve, or central nervous system diseases, and is commonly seen in patients with early-stage epilepsy, rabies, tetanus, hysteria, uremia, etc. The primary disease may increase the excitability of the phrenic nerve or lower the stress threshold of the diaphragm, leading to diaphragmatic flutter. Frequent and continuous episodes can form a stubborn ectopic excitation focus of the phrenic nerve and an abnormal excitation-contraction coupling reaction loop, though the degree of spasm in the two sides of the diaphragm may not be entirely equal.

bubble_chart Clinical Manifestations

When the diaphragm is diseased, diaphragm fluttering causes a sudden increase in negative intrathoracic pressure, forcing air into the upper respiratory tract. As it passes through the partially closed vocal cords, a distinctive sound is produced. During an episode, patients may experience breathlessness, chest pain, and difficulty eating. Prolonged episodes can severely deplete the body's energy reserves. Diaphragm fluttering may also lead to mechanical contractions of the heart and bioelectrical disturbances, disrupting respiratory rhythm and depth. This can result in worsening cardiopulmonary function, severe arrhythmias, or even sudden death.

The diagnosis can be easily made based on the patient's symptoms of breathlessness, chest pain, and inability to eat, along with X-ray findings showing the diaphragm intermittently changing from an upward convex position to a flat position (often occurring during the intermediate stage [second stage] of inhalation or exhalation).

bubble_chart Treatment Measures

In addition to treating the underlying disease cause, sedatives can be administered. For frequent episodes, phrenic nerve crushing, external diaphragm pacing, or audio-frequency electrical therapy may be performed. In severe cases, tracheotomy with artificial or mechanical ventilation is applied.