Hemoptysis as a rare presenting symptom of hypertrophic obstructive cardiomyopathy
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CASE REPORT
Hemoptysis as a rare presenting symptom of hypertrophic obstructive cardiomyopathy Neeraj Kumar 1
&
Anil Kumar 2 & Rakesh Kumar Verma 1 & Vinay Krishna 1 & Anumeet Bagga 1
Received: 17 May 2019 / Revised: 8 June 2020 / Accepted: 17 June 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract A 36-year-old female presented with two episodes of hemoptysis induced by exertion and acute dyspnea. She was diagnosed as a case of hypertrophic obstructive cardiomyopathy (HOCM) with systolic anterior motion (SAM)-induced severe mitral regurgitation (MR). She underwent extended septal myectomy with mitral valve replacement under cardiopulmonary bypass and recovered successfully. This is a unique and rare combination of HOCM with hemoptysis. Keywords Hypertrophic cardiomyopathy . Hemoptysis . Alveolar hemorrhage . Septal myectomy
Introduction Hemoptysis is an uncommon presentation in a number of structural heart diseases, the most common being mitral stenosis. Raised pulmonary capillary pressure leading to alveolar hemorrhage, similar to that seen in mitral stenosis, explains the pathophysiology of hemoptysis in hypertrophic obstructive cardiomyopathy. This report presents an uncommon case of hypertrophic obstructive cardiomyopathy who presented with hemoptysis.
Case report A 36-years-old female came to the outpatient department with complaint of 2 episodes of hemoptysis within 15 days and chest pain. She also complained of dyspnea which had gradually increased over last 4 years. Patient was hemodynamically stable except tachycardia. There were no signs of heart failure like engorged neck veins and pedal edema. Cardiac auscultation revealed normal first and second heart sounds
* Neeraj Kumar [email protected] 1
Cardiovascular and Thoracic Surgery Department, LPS Institute of Cardiology, NT-4/36, Medical College Campus, Kanpur 208002, India
2
Surgery Department, GSVM Medical College, Kanpur, India
and 2/6 systolic murmur over the apex suggestive of mitral regurgitation (MR). Her chest examination revealed bilateral coarse crepitations in mid zones. X-ray demonstrated bilateral diffuse infiltrates. Contrast enhanced computed tomogram of the chest was done which shows bilateral diffuse patchy ground glass opacities (Fig.1). In view of the above findings suggestive of a possible infective etiology, sputum was sent for culture, gram-staining, fungus, and acid-fast bacillus examination, and the analysis was negative. A 2D transthoracic echocardiogram showed asymmetric septal hypertrophy, systolic anterior motion (SAM)-induced severe MR, and peak gradient across left ventricular outflow tract (LVOT) of 53 mmHg in resting phase. Her blood coagulation profile was normal. Patient was treated medically to improve the pulmonary vascular congestion with beta blocker (metoprolol), diuretic (lasilactone), and chest physiotherapy and led to improvement. This was confirmed with repeat computed tomogram scan after 3 weeks which confirmed marked improvement in previous opacities (Fig. 2). Surgic
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