Mitral Stenosis as a Cause of Hemoptysis in Postpartum Women

Clinical Characteristics

• The American College of Cardiology notes that a loud first heart sound indicates mobile valves with sudden and forceful closure, and an opening snap is a diastolic early sound pathognomonic of mitral stenosis 1
• The presence of a third heart sound suggests volume overload and ventricular dysfunction, according to Circulation and the Journal of the American College of Cardiology 2, 3
• Jugular venous distension is evidence of right heart failure secondary to pulmonary hypertension, as reported by Circulation and the Journal of the American College of Cardiology 2, 3

Electrocardiographic Findings

• The American College of Cardiology states that P mitrale, characterized by P waves with a duration >0.12 seconds and notching, reflects left atrial enlargement 1
• The Journal of the American College of Cardiology notes that P waves with a terminal negative component >0.04 seconds in lead V1 confirm left atrial enlargement 1
• Circulation and the Journal of the American College of Cardiology report that pulmonary P waves (peaked) suggest severe pulmonary hypertension with right atrial enlargement, a late finding 2, 3

Radiographic Findings

• The Journal of the American College of Radiology indicates that elevation of the left main bronchus and parahilar interstitial infiltrates are classic signs of chronic pulmonary venous hypertension 4, 5, 6
• The Journal of the American College of Radiology notes that these findings suggest pulmonary hypertension secondary to mitral stenosis, rather than acute pulmonary embolism 4, 5, 6

Echocardiographic Findings

• The American College of Cardiology recommends that echocardiography demonstrate a mitral valve area <1.5 cm² with thickening and restriction of valve leaflets 1
• The Journal of the American College of Cardiology states that morphological features of the mitral valve include thickening (≥5mm), calcification, commissural fusion, and restriction of the subvalvular apparatus 1