SHM Converge Scientific Abstract ePoster Gallery-Beyond the Lungs: Hemoptysis as an Atypical Manifestation of Acute Severe Mitral Regurgitation

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This case highlights hemoptysis as an unusual presentation of acute severe mitral regurgitation (MR). An 80-year-old man with a history including suspected latent TB, smoldering myeloma, and prior pulmonary embolism presented with 4 days of blood-streaked sputum and 2 weeks of dyspnea on exertion. He was tachycardic but oxygenating well, and exam revealed jugular venous distention, coarse right upper lobe crackles, and most importantly, a new grade 2/6 holosystolic apical murmur.<br /><br />Initial evaluation included labs that were largely unremarkable aside from mildly elevated troponin and BNP. CT chest showed interstitial edema, small pleural effusions, and extensive new right-sided bronchocentric ground-glass opacities. Workup for pulmonary embolism and infection, including V/Q scan, AFB smears, MTB PCR, and sputum cultures, was negative. He was initially treated for pneumonia with ceftriaxone and azithromycin.<br /><br />Transthoracic echocardiography revealed findings consistent with acute severe MR superimposed on chronic MR, including pulmonary vein systolic flow reversal, preserved LV size, and preserved ejection fraction with left atrial enlargement. Transesophageal echocardiography identified the mechanism: chordal rupture causing flail of the P3 scallop and prolapse of the P2 scallop of the posterior mitral leaflet, producing an eccentric severe regurgitant jet.<br /><br />The case emphasizes three key lessons: acute severe MR should be considered in patients with hemoptysis; recognition of a new murmur can redirect the diagnosis away from more common pulmonary causes; and early identification of valvular disease is essential for timely cardiology evaluation and mitral intervention. Hemoptysis likely resulted from acute pulmonary venous hypertension and asymmetric, right-sided pulmonary edema related to the eccentric regurgitant jet.

Asset Subtitle

Dana Toy

Meta Tag

Author List Briana Frink, Dana Toy

Category Clinical Vignettes

Concept Severe Mitral Regurgitation

Concept Echocardiography

Concept Hemoptysis

Concept Holosystolic Murmur

Concept Pulmonary Vein Systolic Flow Reversal

Distinguished Non-Finalist

Presenter Organization University of California San Diego, Division of Hospital Medicine

Presenting Author Dana Toy

Track Adult

Keywords

hemoptysis

acute severe mitral regurgitation

chordal rupture

flail posterior mitral leaflet

pulmonary venous hypertension

dyspnea on exertion

ground-glass opacities

new holosystolic murmur

transesophageal echocardiography

pulmonary edema

Severe Mitral Regurgitation

Echocardiography

Hemoptysis

Holosystolic Murmur

Pulmonary Vein Systolic Flow Reversal