diaphragmatic spasm

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Overview of diaphragm spasm

Involuntary spasmodic contraction of the diaphragm can appear uh-oh, chest pain, dyspnea and other symptoms of a variety of diseases, mental psychology, diet, etc. can cause diaphragm spasms in mild cases can be relieved on their own, without special treatment. Severe cases can be treated with physical therapy, acupuncture, medication and surgery.

Definition

Diaphragmatic spasm is an involuntary spasmodic contraction of the diaphragm. When abnormal contraction of the diaphragm occurs, eructation, chest pain, and in severe cases, dyspnea can result [1-3].

The diaphragm is located between the thoracic and abdominal cavities in the shape of a dome and is involved in the body’s respiration and aids in digestion.

Classification

Classification according to the severity of diaphragmatic spasm

  • Mild diaphragmatic spasm: manifests as eructations, which are usually short-lived, with a frequency of 4 to 60 episodes/minute. It is often caused by air entering the stomach during swallowing, eating too fast, or drinking large amounts of carbonated beverages. Upset does not usually have a serious impact on life and in most cases resolves on its own.
  • Moderate diaphragmatic spasm: It is often caused by life habits, emotional fluctuations, improper body position, etc. The frequency of the attack is 60-100 times/minute, which can lead to short-lived dyspnea, chest pain and coughing. It usually requires appropriate adjustment and treatment for the cause.
  • Severe diaphragmatic spasm: also known as diaphragmatic flutter, manifested as rapid, involuntary continuous contraction of the diaphragm, with episodes of diaphragmatic contraction of up to 100 to 300 times/minute. Diaphragmatic flutter will lead to persistent dyspnea, chest pain and other symptoms, and even affect the quality of life in severe cases.

    • Etiology

    Diaphragmatic spasms can be caused by a variety of diseases, psychosomatic and dietary.

    Causes

    Irritating factors

    Inhalation of irritating gases, eating too fast, drinking a lot of carbonated beverages, etc. can lead to brief involuntary contraction of the diaphragm, triggering mild diaphragmatic spasm.

    Neurological factors

  • Neurological disorders such as multiple sclerosis, Parkinson’s disease, etc. or nerve damage may affect the normal function of the diaphragm, thus triggering diaphragmatic spasms.
  • Cerebrovascular disease, especially stroke, is an important factor in causing intractable eructations.
  • Gastrointestinal diseases, malignant tumors, mediastinitis, lower wall myocardial infarction, pericarditis, uremia, lower lobe pneumonia, pleurisy, peritonitis, diaphragmatic ischemia, etc., directly cause stimulation to the diaphragm, resulting in increased excitability of the phrenic nerve, lowering of the diaphragmatic stress threshold, leading to diaphragmatic spasm.

    • Psychological factors

  • Mood fluctuations, anxiety, stress and other psychological factors can affect the function of the nervous system, thus triggering diaphragmatic spasm.
  • Hysterical patients may swallow a lot of air to cause diaphragmatic spasm.

    • Drugs

    Sulfonamides, dexamethasone, methyldopa, barbiturates, diazepam, etc. may cause diaphragmatic spasm.

    Pathogenesis

    Diaphragmatic spasm is a rapid, involuntary contraction of one or a group of muscles of the diaphragm, and superimposed on normal diaphragmatic movement, frequent successive contractions to form intractable foci of ectopic excitation of the phrenic nerve and an abnormal excitation-contraction coupling reaction loop, and diaphragmatic spasm occurs.

    Symptoms

    Diaphragmatic spasm may present with symptoms such as eructation, chest pain, and dyspnea.

    Main symptoms

    Upset

    Upset is the most common symptom of diaphragmatic spasm, which is characterized by transient, involuntary diaphragmatic contractions, usually accompanied by “uh, uh” sounds [4-5].

    Chest pain

    Diaphragmatic spasms may cause discomfort or pain in the chest.

    The degree of chest pain varies depending on the type and intensity of the spasm and may be dull, stabbing, or tight.

    Difficulty breathing

    Diaphragm spasms interfere with normal breathing, resulting in shortness of breath, shortness of air, or difficulty breathing. These symptoms usually appear during the onset of spasms and fade away as the spasms resolve.

    Other symptoms

    Cough

    Diaphragmatic spasms can cause coughing, especially during spasm attacks. The cough is often accompanied by phlegm and may be dry.

    Palpitations

    Some diaphragmatic spasms can trigger palpitations, which are characterized by a rapid or irregular heartbeat.

    Nausea and vomiting

    Episodes of diaphragmatic spasm can lead to nausea and vomiting.

    Complications

    Chronic hiccups

    Persistent or recurrent episodes of hiccups can lead to pain in the mouth, throat, or chest, which can be severe enough to affect quality of life.

    Sleep disturbances

    Diaphragmatic spasms can lead to sleep disorders such as difficulty falling asleep and decreased quality of sleep.

    Fatigue

    Persistent diaphragmatic spasms can lead to symptoms such as fatigue and weakness.

    Respiratory tract infections

    Repeated episodes of diaphragmatic spasms accompanied by nausea and vomiting can increase the risk of respiratory infections.

    Cardiorespiratory insufficiency, arrhythmia, sudden death

    If the attack lasts for a long time, it may lead to severe physical exertion and even mechanical contraction of the heart and bioelectrical disturbances, affecting the rhythm and depth of respiration, resulting in cardiopulmonary insufficiency, severe arrhythmia and sudden death.

    Seek medical attention

    If symptoms related to diaphragmatic spasm occur, you need to seek medical attention. The doctor will ask about symptoms, medical history, previous tests and treatment.

    Department of Medicine

    Neurology

    Neurology is recommended when hiccups and chest pain persist for a long period of time without relief, or are accompanied by symptoms such as nausea, vomiting, and headache.

    Respiratory Medicine

    When the hiccups persist, accompanied by chest pain and dyspnea, respiratory medicine is recommended.

    General Surgery

    General Surgery is recommended for persistent hiccups that cause nausea and vomiting.

    Preparation

    How to get to the doctor: registration, information preparation, FAQs

    Tips for your visit

  • Record the time, duration, and frequency of symptoms, as well as previous related illnesses and drug allergies.
  • Pay attention to lifestyle habits such as diet, exercise and rest, and analyze whether there are factors that may cause spasms.
  • Record the measures taken to relieve the spasms, and the effectiveness of the measures.
  • If relevant tests have been performed, such as routine blood tests and electrolyte tests, bring the test reports with you.

    • Checklist for preparation for medical consultation

    Symptom list

    Particular attention should be paid to the time of onset of symptoms, special manifestations, etc.

  • When did the diaphragmatic spasm occur? How long did it last? How is it relieved?
  • Frequency of attacks?
  • Is there eruption?
  • Is there chest pain, dyspnea?
  • Is there coughing, palpitations, nausea, vomiting?
  • Does it affect daily life, work?
    • List of medical history
  • Are there any digestive, neurological, or respiratory diseases?
  • Are there any family members with diaphragmatic spasms or related diseases?
  • Are there any tumors?
  • Is there a history of cerebrovascular disease?
  • Is there any heart disease?
  • Is there a history of abdominal, thoracic, or spinal surgery?
  • What is the eating rate, diet, exercise habits, and routine?
  • What is your recent psychological state? Any mood swings?
    • Checklist

    Examination results of the last six months, which can be brought to the doctor’s office

    Imaging tests: X-ray, ultrasound, CT, MRI, etc.

    Medication list

    Medication used in the last 3 months, if available in boxes or packages, bring with you to the doctor’s office

  • Muscle relaxants: Baclofen.
  • Others: sulfasalazine, dexamethasone, methyldopa, barbiturates, etc.

    • Diagnosis

    The diagnosis of diaphragmatic spasm relies on the patient’s history, symptoms, and relevant ancillary findings.

    Diagnosis is based on

    Medical history

  • History of digestive, neurologic, respiratory, cardiac, and cerebrovascular diseases.
  • Family history of diaphragmatic spasm.
  • History of tumor.
  • Eating too fast or drinking a lot of carbonated beverages, etc.

    • Clinical manifestations

    Typical symptoms of diaphragmatic spasms, such as eructation, chest pain, dyspnea, etc.

    Imaging examination

    X-ray examination

    X-ray examination can help to observe the structures of the chest, abdomen and spine, and understand the position, shape and movement of the diaphragm. X-rays allow doctors to rule out abnormalities in the chest, abdomen and spine, such as lung infections and scoliosis.

    Paroxysms of the diaphragm changing from an upwardly convex position to a flat one are seen on X-ray.

    Ultrasound

    Ultrasonography can visualize the thickness, shape and movement of the diaphragm. In addition, ultrasonography can evaluate the structure and function of organs in the abdominal and thoracic cavities to rule out other diseases.

    In the case of diaphragmatic spasm, ultrasonography can show abnormal diaphragmatic contraction and restricted movement.

    CT

    A CT examination provides more detailed information about the structures of the chest, abdomen and spine for lesions involving the diaphragm.

    In diaphragmatic spasm, CT shows features such as uneven thickness and abnormal morphology of the diaphragm.

    MRI

    MRI provides detailed information about soft tissues such as the diaphragm, nerves, and blood vessels, etc. MRI is also helpful in identifying neurologic disorders and muscular disorders.

    Diaphragmatic spasm often shows abnormal diaphragmatic signal and rupture of muscle fibers.

    Laboratory Tests

  • Routine blood tests: to assess the presence of inflammation, anemia, etc. in the patient.
  • Liver and kidney function, electrolytes: used to monitor liver and kidney function, assess the patient’s liver and kidney condition as well as nutritional status and the presence of electrolyte disorders.
  • Coagulation function: to monitor whether the patient has coagulation dysfunction.

    • Differential Diagnosis

    Diaphragmatic spasms need to be differentiated from the following conditions.

    Pleurisy

  • Similarities: Pleurisy can cause symptoms such as chest pain and dyspnea, similar to diaphragmatic spasm.
  • Differences: Pleurisy is usually accompanied by fever and cough. Chest X-ray, ultrasound and other imaging tests, as well as blood tests, can distinguish the two.

    • Angina pectoris

  • Similarities: Angina pectoris is mainly characterized by chest pain, similar to that of diaphragmatic spasm.
  • Differences: Chest pain in angina pectoris is usually associated with increased cardiac load and can be relieved with rest or nitroglycerin. The two can be differentiated by ECG, cardiac ultrasound and other tests.

    • Treatment

  • Aim of treatment: Relieve symptoms, correct predisposing factors, prevent complications and improve quality of life.
  • Treatment principle: according to the severity of spasm, choose different treatment methods [6-10].

    • General treatment

    Mild diaphragmatic spasm can mostly be relieved on its own and usually requires no treatment. Some of them can be terminated by deep inhalation followed by breath-holding, pressure on both eyeballs method, pressure on supraorbital nerve method, carotid sinus compression method and so on.

    Patients should pay attention to rest, avoid stimulating food and drinking a lot of carbonated beverages, and control their emotions.

    Physical therapy

    Diaphragmatic spasm is related to muscle tension, and physical therapy methods such as hot compresses and massages can be used to relieve the symptoms.

    Acupuncture

    Acupuncture and moxibustion can be used to improve the symptoms of diaphragmatic spasms, such as Zanzhu acupoint, Chengjian acupoint, Neiguan acupoint, Gongsun acupoint, Shusanli, Cataract acupoint, Tiantu acupoint, and other related acupoints.

    Medication

    Drug therapy is suitable for patients with severe spasticity that affects the quality of life.

    Commonly used drugs include antispasmodics such as belladonna alkaloids, calcium channel blockers such as nifedipine, central stimulants such as Ritalin, proton pump inhibitors such as cimetidine and omeprazole. Baclofen, metoclopramide, and chlorpromazine may also be used.

    Treatment of the cause of the disease

    Actively treat the primary disease and search for the cause. If the intractable hiccups are caused by cerebrovascular disease, the primary disease needs to be actively treated in order to effectively relieve the symptoms of diaphragmatic spasm. If the diaphragmatic spasm is related to gastroesophageal reflux, electrolyte imbalance (low blood calcium, low blood magnesium), etc., the relevant diseases should be treated.

    Surgical treatment

    If diaphragmatic spasm seriously affects the quality of life and conservative treatment is ineffective, surgical treatment can be considered.

    Unilateral or bilateral phrenic nerve block, cervical paracentesis or phrenic nerve compression are commonly used in clinical practice.

    Prognosis

    The prognosis of diaphragmatic spasm varies with individual differences and the cause of spasm.

    Cure

    In general, the prognosis for mild diaphragmatic spasms is good, and most patients are able to manage their symptoms effectively with conservative treatment and lifestyle modifications. For moderate to severe diaphragmatic spasms, medication and cause-specific treatment can also relieve symptoms and improve quality of life.

    Hazards

    Diaphragmatic spasms by themselves usually do not cause serious physical harm, but they may lead to symptoms such as chest pain and difficulty breathing, which can affect a patient’s quality of life.

    In addition, diaphragmatic spasms may be exacerbated if they are associated with other medical conditions (e.g., gastroesophageal reflux, heart disease, etc.).

    Daily

    Patients with diaphragmatic spasm need to pay attention to their daily diet and life. If diaphragmatic spasms occur frequently, prompt medical attention is needed.

    Daily management

    Dietary management

    Avoid stimulating foods and drinks, such as spicy and greasy foods, coffee, strong tea, etc. to avoid inducing diaphragmatic spasm.

    Lifestyle management

  • Maintain a good routine, avoid overwork, and ensure sufficient rest and sleep.
  • Learn to adjust your emotions and reduce stress, and participate in yoga, meditation and other mental adjustment activities if necessary.
  • Exercise appropriately to enhance physical fitness, such as walking, swimming and other sports.
  • Do not eat too fast and do not drink a lot of carbonated beverages.

    • Disease monitoring

    Pay attention to the frequency and degree of episodes of diaphragmatic spasm and observe the changes in symptoms. If diaphragmatic spasms occur frequently, chest pain and dyspnea require prompt medical attention.

    Follow-up and review

    According to the doctor’s advice and personal condition, regular review. In general, the review can be done 1 to 3 months after treatment.

    Review items include: medical history questioning, physical examination, electrocardiogram, chest X-ray and so on.

    Prevention

  • Pay attention to dietary habits, avoid eating too fast and avoid consuming stimulating foods.
  • Maintain a good work routine and avoid fatigue and stress.
  • Learn to manage stress and make psychological adjustment.
  • Maintain appropriate physical exercise to enhance physical fitness.
  • Actively treat the primary disease.