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Surgical management of interventricular septal rupture.

A 76-year-old man who was being treated for longstanding hypertension presented to an outside hospital with 1 week of ongoing shortness of breath. His symptoms started while driving 1 week before admission, when he experienced a sudden onset of severe nausea, followed by four episodes of emesis and shortness of breath. He was transferred to the University of Vermont Medical Center Emergency Department for further management. Upon arrival, he was in respiratory distress with a temperature of 36.5°C, a respiratory rate of 26, a heart rate of 79, blood pressure of 132/81, and O2 saturation of 97% on 2 l nasal cannula. An examination indicated a III/VI holosystolic murmur.