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Palpitations in a young man after heavy work
  1. Abhishek Thakur1,
  2. Sumit Kumar2
  1. 1 Department of Cardiology, National Cardiac Centre, Kathmandu, Nepal
  2. 2 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Abhishek Thakur, Cardiology, National Cardiac Centre, Kathmandu, Nepal; abhishekthakur1039{at}

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Clinical introduction

A man in his 30s presented with palpitations and worsening dyspnoea for 2 weeks, which started after a bout of heavy work. On examination, his blood pressure was 140/60 mm Hg, and his heart rate was 102 beats/min. Cardiovascular examination was notable for a high-volume collapsing pulse and a continuous murmur heard over the entire precordium. Transthoracic echocardiography was performed (figure 1, online supplemental file 1).

Supplementary video

Figure 1

Transthoracic echocardiography. (A) Parasternal long-axis view showing a tubular structure between the right coronary sinus and the right ventricle (arrowhead). (B) Colour Doppler across the defect shows turbulent flow across the defect. (C) Modified short-axis view shows a prominent defect (arrow). (D) Colour Doppler across the defect showing high-flow jet across the shunt.


What is the cause of the patient’s murmur and dyspnoea?

  1. Ruptured sinus of Valsalva. …

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  • Contributors AT and SK were involved in conceptualisation and drafting of the manuscript. AT revised and finalised the manuscript. All the authors discussed the results and implications and commented on the manuscript at all stages.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.