Chest pain and dyspnea in a young man.

A 27-year-old man presented with sudden onset chest pain associated with dyspnea for the preceding 1 week. He also reported typical angina for the past 3 months. Clinical examination revealed a continuous murmur in the upper left parasternal region. Echocardiography revealed a ruptured left sinus of Valsalva aneurysm communicating with the left atrium. CT angiogram confirmed a ruptured large aneurysm of the left sinus of Valsalva freely communicating with the left atrium via a long fistulous tract. Additionally, the tract resulted in partial compression of the left main coronary artery. A ruptured sinus of Valsalva aneurysm represents an important differential in young adults presenting with acute onset chest pain and heart failure. Fistulous tracts arising from the left sinus may result in compression of the left coronary system and sudden cardiac death making this a unique entity to recognize.