Abstract
Acute upper GI bleeding is a common medical emergency with a hospital mortality of approximately 10%. Non variceal UGI bleeding is the most common cause followed by oesophageal varices. Various rare causes have been described in the literature but there are very few cases of giant left atrium leading to oesophageal erosion and causing upper GI bleeding. We are presenting a case of rheumatic valvular heart disease with giant left atrium who presented in our department with acute upper GI bleeding.
Highlights
In mitral valvular heart disease, mostly mitral stenosis alone or with mitral insufficiency, the left atrium dilates and hypertrophies
Most of the case reports of giant left atrium are due to rheumatic pathology which is a common health problem in the developing countries. 1,2,3 But there are few reports with a non-rheumatic etiology
In developing countries where rheumatic heart disease is common, Ates et al suggested giant left atrium to be diagnosed when it is more than 10 cm in diameter while reporting a giant left atrium of 18.7 cm.[11]
Summary
In mitral valvular heart disease, mostly mitral stenosis alone or with mitral insufficiency, the left atrium dilates and hypertrophies. The left atrium reaches extreme sizes as a result of increasing pulmonary artery pressure contributing to an increase in right side pressure and unfavorably affects morbidity and mortality rates due to complications like atrial fibrillation, heart failure, thromboembolism, pressure effects on surrounding structures producing dysphagia, causing erosions of the oesophagus etc. A giant left atrium can be assessed by a chest xray showing massive cardiomegaly with increased cardiothoracic ratio. Transthoracic echocardiography is the easiest method to diagnose giant left atrium
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