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Haemoptysis in Mitral Stenosis — EECC MCQ

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ModerateValvular Heart DiseaseHaemoptysis in Mitral StenosisEECC

A 55-year-old woman with severe rheumatic MS (MVA 0.8 cm²) and NYHA III symptoms in sinus rhythm develops haemoptysis. What is the mechanism?

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Correct answer: C — Pulmonary venous hypertension from elevated LA pressure causes rupture of bronchial-pulmonary venous anastomoses and pulmonary vein varices — haemoptysis in MS indicates significant pulmonary venous congestion

Haemoptysis is a classic but now less common complication of severe MS. Mechanisms include: (1) rupture of dilated bronchial-pulmonary venous anastomoses (the most common cause) — elevated LA pressure is transmitted retrogradely to the pulmonary veins, causing dilatation and eventual rupture of bronchopulmonary anastomotic vessels; (2) pulmonary apoplexy (alveolar haemorrhage from rupture of pulmonary capillaries); (3) pulmonary embolism/infarction (AF-related); (4) frank pulmonary oedema (pink frothy sputum). Haemoptysis in MS is an indication for intervention (PMBC if favourable anatomy, or surgical MVR). The ESC VHD Guidelines note that haemoptysis has become uncommon in developed countries due to earlier detection and treatment of MS.

Reference: ESC/EACTS (2025): VHD Guidelines