This was a 55 year old lady who was being evaluated for history of one episode of  hemoptysis 3 days before she presented to our clinic. On questioning she gave history of mild breathlessness on   exertion and paroxysmal nocturnal dyspnoea occasionally.

Her chest xray showed mild cardiomegaly , prominent right pulmonary artery and right lower lobe pneumonitis changes.

Her EKG showed normal sinus rhythm and left atrial enlargement.

Her Echo cardiogram showed the following findings :

mitral leaflets are thickened
anterior mitral leaflet shows doming

left atrium is enlarged

mitral valve prolapse is also seen

colour doppler shows the classical candle flame sign

pressure half time calculation reveals moderate mitral stenosis

another normal mitral flow clipping is given below for comparison :

This patient had Rheumatic heart disease , moderate mitral stenosis with pulmonary hypertension .