A young man with acute heart failure and a holodiastolic murmur.

A young man in his 20s presented to the emergency department with a 2-week history of dyspnoea and fever. His medical history was remarkable for recurrent episodes of fever with arthralgia in childhood f. Clinical examination revealed pedal oedema, bounding pulses and a holodiastolic murmur. Additionally, chest auscultation revealed bibasilar crackles. The ECG showed sinus tachycardia with features of left ventricular volume overload. Two-dimensional transthoracic echocardiography was performed and …