Critical Care Medicine-Pulmonary Disorders>>>>>Thromboembolic Disease and Hemoptysis
Question 6#

A 24-year-old male with no major medical history has been receiving treatment for a lower respiratory tract disease for the past 5 days. He had a large bout of hemoptysis this evening, which prompted his visit to the emergency room. His BP is 120/70 mm Hg, HR 120/min, and RR is 30/min. Physical examination reveals bilateral rales and a diastolic murmur.

Patients with which of the following valvular disorders are MOST likely to present with hemoptysis?

A. Tricuspid stenosis
B. Mitral stenosis
C. Aortic stenosis
D. Aortic regurgitation

Correct Answer is B

Comment:

Correct Answer: B

Massive hemoptysis is most commonly defined as a volume over 500 mL in 24 hours or over 100 mL per hour. Hemoptysis could be the presenting symptom in a patient with mitral stenosis, although uncommon in patients with a known diagnosis. Several pathophysiological mechanisms have been postulated for this presentation. In patients with severe MS, shunts occur between the pulmonary and bronchial venous vasculature. Rupture of these vessels could result in hemoptysis which could occasionally be massive resulting in pulmonary apoplexy. Other causes of hemoptysis in patients with mitral stenosis include pulmonary edema and infarction.

References:

1. Thomas J, Bonow R. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, Chapter 69. 11th ed. 1415-1444.
2. Wood P. An appreciation of mitral stenosis. Br J Med. 1954;1:1051, 1113.