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Acute mitral valve regurgitation causing severe alveolar hemorrhage
Ayaka Sakamoto1, Yuki Enomoto1, Hiroaki Watabe1
1Department of Emergency and Critical Care Medicine University of Tsukuba Hospital Tsukuba Japan.
Acute Medicine & Surgery
|May 21, 2020
Summary
Acute mitral regurgitation can cause severe alveolar hemorrhage, even without shock. Dyspnea and right-sided lung infiltrates on chest X-rays may indicate this condition.
Area of Science:
- Cardiology
- Pulmonology
- Critical Care Medicine
Background:
- Acute mitral regurgitation (AMR) can present atypically, without hemodynamic instability.
- Symptoms may include dyspnea, hemoptysis, and radiographic evidence of right-sided lung infiltration.
- This case highlights a severe presentation of alveolar hemorrhage secondary to AMR.
Observation:
- A hemodynamically stable 40-year-old male presented with dyspnea and hemoptysis.
- Initial investigations, including chest radiography and bronchoscopy, revealed right-sided infiltration and bloody secretions.
- Echocardiography ultimately diagnosed severe mitral regurgitation due to ruptured chordae tendineae.
Findings:
- Severe alveolar hemorrhage was directly attributed to acute mitral regurgitation.
- The absence of shock in the presence of severe symptoms was a key diagnostic challenge.
- Ruptured mitral chordae tendineae were identified as the cause of the mitral regurgitation.
Implications:
- Alveolar hemorrhage, particularly with right-sided infiltrates, should raise suspicion for acute mitral regurgitation.
- Early echocardiographic evaluation is crucial for diagnosing AMR in patients with unexplained respiratory distress and hemoptysis.
- This case broadens the clinical spectrum of AMR presentation and its potential pulmonary manifestations.
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