Background: Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly which has potential for spontaneous\nrupture into other cardiac chambers or the pericardial space (depending on its location). A ruptured SVA has a very\npoor prognosis with high morbidity and mortality. The development of a shunt between the sinus of Valsalva and\nright-sided cardiac chambers results in a continuous murmur on examination. Our case report is a case of SVA\nrupture into the right atrium.\nCase presentation: In this case report, we describe a 23-year-old patient with an acute onset of chest pain,\nshortness of breath, palpitations and dizziness starting 2 days prior to presentation to the emergency department.\nThe patient was initially treated for presumed pulmonary embolism overnight while awaiting CTPA the next\nmorning. However, further examination by the inpatient medical team demonstrated a continuous machinery\ncardiac murmur. Subsequent echocardiography demonstrated an acutely ruptured SVA with shunting to the right\natrium. Emergency surgical repair resulted in an excellent outcome for the patient.\nConclusion: A thorough clinical history and physical examination is the cornerstone of all medical encounters. An\nSVA could be asymptomatic until acute rupture. Echocardiography is the preferred initial diagnostic tool. Additional\nimaging techniques can be used to confirm the diagnosis. In cases of rupture, prognosis is poor and surgical repair\nis always required.
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