Abstract
Sir, A 56-year-old lady who was a lifelong non-smoker was admitted with acute pulmonary oedema. Echocardiography revealed severe aortic valve regurgitation and a left ventricular ejection fraction of 35–40% associated with moderate left ventricular dysfunction. Coronary angiography confirmed aortic regurgitation, as well as 60% stenosis in the left anterior descending artery with diffuse disease of the distal vessel. Three years earlier, she had been diagnosed with systemic hypertension and was prescribed an angiotensin-converting-enzyme inhibitor. Two months prior to this admission, she was admitted acutely with left ventricular failure and complete heart block, successfully managed with diuretics and insertion of a dual chamber permanent pacemaker. A clinical diagnosis of Churg-Strauss syndrome had been made 20 years …
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