Hemoptysis in rheumatic heart disease

Abstract

1.1. Fifty cases of rheumatic heart disease in which hemoptysis occurred are analyzed. This complication is encountered in at least 10 per cent of all adults with rheumatic heart disease who are admitted to a general hospital. In our series, the average age at the onset of hemoptysis was 33.4 years.2.2. The symptoms most commonly associated with hemoptysis were palpitation, pain in the chest, and dyspnea.3.3. The associated anatomic, pathologic, and physiologic abnormalities, in the order of their frequency, were 3.1.(a) Mitral stenosis, in all but one case.3.2.(b) Pulmonary infarction, in twenty-three cases.3.3.(c) Multiple valve involvement, in twenty-two case3.4.(d) Chronic auricular fibrillation, in twenty cases. Paroxysmal arrhythmia, in five cases.3.5.(e) Marked cardiac enlargement, in nineteen eases.3.6.(f) Active rheumatic infection, in twelve cases.3.7.(g) Congestive failure, in eight cases.3.8.(h) At autopsyEasily recognizable pulmonary vascular sclerosis in six cases.Right auricular thrombi in three cases.4.4. The prognosis and the mechanism of hemoptysis are discussed.5.5. It is noteworthy that only eight patients had congestive failure prior to, or at the time of, the initial hemoptysis, and that nine had hearts of normal size. Pulmonary infarction is the most likely cause when there is congestive failure and may be excluded when the heart is of normal size. The combination of pulmonary infarction, a heart of normal size, and progressive cardiac enlargement following hemoptysis may indicate a severe grade of pulmonary arteriosclerosis.6.6. The occurrence of hemoptysis in a case of rheumatic heart disease may help in distinguishing between an Austin-Flint murmur and the murmur of aortic regurgitation, or in the diagnosis of mitral stenosis, in certain cases.7.7. When hemoptysis occurs in rheumatic heart disease, only occasionally is it caused by something other than the heart disease.