Combined mitral stenosis and coronary artery disease: A clinical syndrome characterized by paroxysmal pulmonary edema with rapid resolution

Four women, aged 57 to 75 years, were hospitalized for the abrupt onset of pulmonary edema, which resolved within 24 hours after small doses of intravenous diuretic drugs. In 2 patients, these clinical episodes were recurrent. Cardiac catheterization was performed in 3 patients (Table I) and moderate to severe MS and significant CAD were documented in each. Left ventricular (LV) ejection fractions ranged from 53 to 62%; left ventricular end-diastolic pressures were normal. One patient died before cardiac catheterization could be performed, but severe MS was diagnosed by 2-dimensional echocardiography and CAD was documented by enzymatic and electrocardiographic evidence of acute anterolateral myocardial infarction after repeated episodes of recurrent pulmonary edema. In our 2 oldest patients, aged 75 and 77 years, classic ischemic discomfort did not occur, and MS was not detected by clinical examination.