Why does chest squeezing trigger stridor in my brother?

Question

Hello doctor,

When my brother squeezes his chest intentionally by crossing his hands over his chest, he starts having difficulty breathing, swallowing, and stridors. But it suddenly resolves if he stops the squeezing. Additionally, if he coughs forcefully, it produces a sound similar to stridors. Also, he has a mild pressure-like feeling if he lies in a face-up position.

He also has visible external jugular veins on both sides that seem to pulsate while lying in this face-up position. Like his mother and sisters, he has visible veins all over his body. And his other family members also have this in common. He had a pressure-like feeling when he bent down, which the doctors said was normal in healthy people. But if he does push-up exercises, he has a red face.

If he holds his breath (for clearing his ears in case), his right SCM (sternocleidomastoid) muscle becomes more prominent and raised than the left. I think this asymmetry in the SCM muscle is due to his work with heavy backpacks, as his sister also seems to have it. Please reassure him, as he trusts your words.

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Let me carefully explain what you described about your 23-year-old brother, point by point, and offer reassurance. First, about stridor and breathing difficulty on chest squeezing, when he intentionally squeezes his chest with crossed arms, he experiences increased pressure inside his chest (like a “self-bear hug”).

This can temporarily compress the airway or trachea from outside, or alter airflow, making a stridor-like sound and difficulty breathing. Once he stops squeezing, the pressure is gone, and everything returns to normal. This is a mechanical, self-induced effect, not a disease.

Stridor-like sound during forceful cough is heard. A very strong cough can make the upper airway vibrate noisily, sometimes sounding like stridor. In healthy young adults, this can happen occasionally. It is not abnormal if it occurs only with forceful coughing.

Pressure feeling when lying face-up (supine) occurs. When lying flat, blood return to the chest increases, which can cause a mild feeling of pressure. If he has prominent veins, this can be more noticeable. Since it is mild and not associated with fainting or severe breathlessness, it is usually benign.

In case of visible external jugular veins and body veins, you mentioned visible, pulsating veins in your brother, his mother, and his sisters. This suggests a familial trait of prominent superficial veins (thin skin venous prominence). In the absence of swelling of legs, shortness of breath, or heart disease, this is usually just a normal variant.

He experiences a red face with push-ups or bending down. During push-ups, bending, or straining, intrathoracic pressure rises, the face becomes red, and veins distend. This happens even in healthy athletes due to the Valsalva maneuver effect. it is physiological and not harmful if it resolves immediately after exercise.

The right SCM muscle becomes prominent during breath-holding. When he holds his breath and increases chest pressure, neck muscles (especially SCM) tense up to stabilize the airway and chest. If one side looks more prominent, it can be due to habit, posture, or backpack weight training. Mild asymmetry is common. This is not a sign of disease if both sides function normally.

I suggest reassurance from what you describe. Symptoms only occur with intentional chest squeezing, forceful coughing, or straining not at rest. Veins are prominent in multiple family members, suggesting a normal familial trait. If there is no observation of constant breathlessness, fainting, swelling of legs, chest pain, or bluish lips, this would not raise concern for serious heart or lung problems.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.