To the Editor.—Mitral stenosis is a slowly progressive disease. Activity level is often subconsciously reduced, such that symptoms are often underestimated by both the patient and the physician. While orthopnea and paroxysmal nocturnal dyspnea are usually present in severe disease, pulmonary edema may present acutely and is associated with effort, emotional stress, respiratory infection, fever, sexual intercourse, pregnancy, fluid overload, atrial fibrillation with a rapid ventricular response or other tachycardia, and any state of suddenly increased cardiac output.1I would like to describe an episode of life-threatening pulmonary edema acutely precipitated by pelvic examination in a woman whose symptoms became more impressive in retrospect.
Report of a Case.—A 59-year-old woman with a diagnosis of moderate mitral stenosis with chronic atrial fibrillation led an active life and was thought to have only mild intermittent pulmonary symptoms. Admission to an outside hospital was precipitated by sudden shortness of breath