A 35-year-old male presented with symptoms of shortness of breath and ankle oedema which had developed within a few days. The symptoms had started suddenly following a mountain bike trip. Physical examination revealed a blood pressure of 90/40 mmHg, no fever and a continuous murmur on auscultation of the heart, as well as signs of left and right heart failure.
Echocardiography showed moderate pericardial effusion and a hyperdynamic left and right ventricle with signs of right ventricular volume overload. Turbulent flow was seen in the aortic root and a shunt was demonstrated from the aortic root to the right atrium (figure 1) through a ruptured sinus Valsalva aneurysm of the non-coronary cusp (figure 2).
