Haemoptysis in Eisenmenger — EECC MCQ

Correct answer: E — Haemoptysis in Eisenmenger can result from pulmonary artery rupture, pulmonary infarction, or bronchial artery collateral bleeding; it is a life-threatening emergency requiring supportive care, avoiding anticoagulation if massive, and bronchoscopy/embolisation if a source is identified

Haemoptysis in Eisenmenger syndrome is a feared complication occurring in approximately 20% of patients during their lifetime. Causes include: (1) rupture of hypertensive pulmonary arteries or thin-walled pulmonary arteriovenous connections; (2) pulmonary infarction from in situ thrombosis; (3) bronchial artery collateral bleeding (bronchial arteries hypertrophy in response to reduced pulmonary blood flow). Massive haemoptysis (>300 mL/24h) is life-threatening. Management: (1) stabilisation (airway, oxygen — but avoid high-flow O₂ which may reduce PVR and increase pulmonary blood flow); (2) withhold anticoagulation if bleeding is significant; (3) bronchoscopy for localisation; (4) bronchial artery embolisation for identified sources. ASD closure is absolutely contraindicated in Eisenmenger (removing the pressure-relief shunt would cause acute RV failure and death).

Reference: ESC (2020): ACHD Guidelines; ESC (2022): PH Guidelines