Coital Hemoptysis: A Rare Presentation of Hypertrophic Cardiomyopathy

Document Type

Conference Proceeding

Publication Date

4-2-2024

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Hypertrophic cardiomyopathy (HCM) has a prevalence of 1:500. Patients typically present with dyspnea, syncope, or angina. We describe a case of a young male who presented with coital hemoptysis. Case: A 39-year-old male with history of hypertension and erectile dysfunction presents to the ER with 6 months of coital hemoptysis and cough. Outpatient, he was treated for pneumonia without improvement. On presentation, chest CT showed nodular ground glass opacities (GGOs). Extensive work up ruled out any infectious or autoimmune etiology. Transthoracic echo revealed peak gradient across the left ventricular outflow tract of 131 mmHg, and systolic anterior motion (SAM) of the mitral valve anterior leaflet. Cardiac MRI was consistent with basal septal hypertrophy with asymmetry measuring 1.5 cm and SAM with posteriorly directed mitral regurgitation. No evidence for myocardial infiltration, and the pattern of late gadolinium enhancement was typical for HCM. Decision-making: Verapamil rather than a beta blocker was initiated to avoid sexual dysfunction. With sudden cardiac death in his brother, a defibrillator was placed. Lisinopril and Sildenafil were discontinued, and he is following up for further management. Conclusion: Coital hemoptysis is a rare presentation of HCM. It results from elevated pulmonary capillary pressure causing alveolar hemorrhage which appears as GGOs on CT making the diagnosis challenging. In cases of exertional hemoptysis, a cardiac evaluation should be considered.

Volume

83

Issue

13 Suppl

First Page

3174

Comments

American College of Cardiology 73rd Annual Scientific Session & Expo, April 6-8, 2024, Atlanta, GA

DOI

10.1016/S0735-1097(24)05164-7

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