Thursday, January 26, 2017

Q: Why auscultation of heart is an important component in the evaluation of hemoptysis?

Answer: To rule out mitral stenosis or mitral regurgitation as a cause of hemoptysis

Though not high on the list, but the presence of murmur of mitral valve should raise the possibility of the cardiac source of hemoptysis. This can be supplemented with echocardiography and evaluation of upper lobes of lungs via radiological workup.

References and further readings:

1. Ramsey HW, de la Torre A, Bartley T, et al: Intractable hemoptysis in mitral stenosis. Ann Intern Med 1967; 67:588-593

2. P. A. Schnyder, A. M. Sarraj, B. E. Duvoisin, L. Kapenberger, and M. J.-M. Landry, “Pulmonary edema associated with mitral regurgitation: prevalence of predominant involvement of the right upper lobe,” The American Journal of Roentgenology, vol. 161, no. 1, pp. 33–36, 1993.

3. H. W. Ramsey, A. de la Torre, T. D. Bartley, and J. W. Linhart, “Intractable hemoptysis in mitral stenosis treated by emergency mitral commissurotomy,” Annals of Internal Medicine, vol. 67, no. 3, pp. 588–593, 1967.

4. T. H. Spence and J. C. Connors, “Diffuse alveolar hemorrhage syndrome due to “silent” mitral valve regurgitation,” Southern Medical Journal, vol. 93, no. 1, pp. 65–67, 2000.

5. K. Woolley and P. Stark, “Pulmonary parenchymal manifestations of mitral valve disease,” Radiographics, vol. 19, no. 4, pp. 965–972, 1999.

 6. A. W.-T. Yeung, H. P. Shum, G. S.-M. Lam, K. K.-C. Chan, S. K. Li, and W. W. Yan, “Diffuse alveolar hemorrhage and intravascular hemolysis due to acute mitral valve regurgitation,” Critical Care and Shock, vol. 16, no. 1, pp. 3–7, 2013.

7. U. Kim HG, D. H. Kim, S. H. Lee et al., “Diffuse alveolar hemorrhage due to acute mitral regurgitation,” Journal of Cardiovascular Ultrasound, vol. 15, no. 1, pp. 16–18, 2007.

8. J. M. Roach, K. C. Stajduhar, and K. G. Torrington, “Right upper lobe pulmonary edema caused by acute mitral regurgitation: diagnosis by transesophageal echocardiography,” Chest, vol. 103, no. 4, pp. 1286–1288, 1993.

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