Massive cardiomegaly secondary to rheumatic heart disease

¹Department of Respiratory Medicine, Datta Meghe Medical College, Nagpur, Datta Meghe Institute of Higher Education and Research (DMIHER), (Deemed University), Sawangi (Meghe), Wardha, Maharashtra, India

^&Corresponding author
Gaurang Aurangabadkar, Department of Respiratory Medicine, Datta Meghe Medical College, Nagpur, Datta Meghe Institute of Higher Education and Research (DMIHER), (Deemed University), Sawangi (Meghe), Wardha, Maharashtra, India

Image in medicine    

A 54-year-old female patient presented to the respiratory physician with chief complaints of dyspnea on exertion, dysphagia, and chest pain. The patient´s past medical history revealed a diagnosis of rheumatic heart disease, which was initially diagnosed 8 years back and a recent echocardiography report was suggestive of severe mitral stenosis with a left ventricular ejection fraction (LVEF) of 28%. An esophagoscopy was done given dysphagia which revealed no obvious abnormalities of the esophageal mucosa. A chest X-ray postero-anterior (PA) view was done which revealed the presence of a massive cardiomegaly with a cardiothoracic ratio of 0.80 (normal cardio-thoracic ratio <0.50). A cardiologist's opinion was taken and the patient was started on angiotensin-converting enzyme (ACE) inhibitors, oral furosemide (diuretic), and carvedilol (beta-blockers), along with regular follow-up. The patient was discharged with the same advice after 5 days of admission. Gross cardiomegaly is a rare complication of rheumatic heart disease, usually seen in patients with severe mitral stenosis, and occurs as a result of altered cardio-pulmonary hemodynamics arising as a result of valvular pathology. Such patients usually present with complaints of dyspnea and dysphagia arising as a result of the considerable enlargement of the cardiac dimensions. This clinical image aims to highlight this striking presentation of gross cardiomegaly that is seen to occupy more than 75% of the hemithorax in horizontal dimensions.

Figure 1: chest X-ray postero-anterior (PA) view demonstrating gross cardiomegaly in a patient with rheumatic heart disease