A Curious Case Of Chronic Thromboembolic Pulmonary Hypertension, Mitral Valve Stenosis, And Nephropathy In A 24-Year-Old Native American Man

A 24-year-old Native American man with a history of microscopic hematuria of unknown etiology presented with cough, shortness of breath, and hemoptysis. Exam was notable for hypoxemia, tachycardia, and the absence of fever. A chest radiograph revealed cardiomegaly and pulmonary edema. Echocardiogram revealed mitral valve stenosis (MVS) with a rheumatic-appearing valve and moderate mitral valve disease. Right heart catheterization demonstrated severe pulmonary hypertension out of proportion to left heart disease, with …