Post coital hemoptysis.

Ischemic mitral regurgitation is a complication of coronary artery disease specifically in the settings of prior myocardial infarction. It is a dynamic lesion and its severity may increase with different forms of exercise leading to flash pulmonary edema. We present the case of an 81-year-old man with ischemic mitral regurgitation who presented with long standing history of hemoptysis limited to sexual intercourse only. After a thorough negative work-up for the usual causes of hemoptysis, comprehensive right and left cardiac catheterization studies revealed marked increase in baseline mitral regurgitation and pulmonary capillary wedge pressure with isometric exercise. This case illustrates that sexual intercourse, a form of isometric exercise, can cause severe increase in ischemic mitral regurgitation and more so compared to other forms of exercise due to heightened sympathetic activity, leading to flash pulmonary edema and hemoptysis.