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Diffuse Alveolar Hemorrhage in Cardiac Diseases

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Abstract

Diffuse alveolar hemorrhage (DAH) is a rare condition with reported mortality ranging between 20 and 100%. There are many etiologies of DAH. Cardiac diseases are likely underreported causes of DAH. Heart failure and mitral valve diseases are the most common cardiac causes of DAH. The DAH results from pulmonary venous hypertension leading to stress failure of the pulmonary capillaries. There is also a contribution of the bronchial circulation. The Alveolar-capillary membrane or blood-gas barrier is an extremely thin structure that allows rapid and passive diffusion of oxygen from the inhaled air to the pulmonary capillaries while preventing pulmonary edema and DAH with chronic elevation of the transmural hydrostatic pressure. The purpose of this manuscript is to inform the clinician about this rare cause of DAH, which may be overlooked unless specifically sought after. We also discuss the pathophysiologic aspects of DAH and the safety mechanisms in place to prevent such occurrences.

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Acknowledgement

The authors would like to acknowledge Alyssa Bonnier for her assistance with the preparation of schematic for the pulmonary and bronchial circulation.

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  1. Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, 1100 Kentucky Avenue, West Plains, Missouri, 65775, USA

    Biplab K. Saha

  2. Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, 12208, USA

    Woon H. Chong

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BKS and WHC were involved in the planning, collection of data and the preparation of initial and final manuscript.

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Correspondence to Biplab K. Saha.

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Saha, B.K., Chong, W.H. Diffuse Alveolar Hemorrhage in Cardiac Diseases. Lung 199, 103–112 (2021). https://doi.org/10.1007/s00408-021-00433-x

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