Infective endocarditis (IE) typically presents with fever, a new or changing cardiac murmur, and embolic phenomena. Acute respiratory failure (ARF) as the dominant presenting feature, without overt cardiac signs, is uncommon and creates significant diagnostic challenges. We present a previously healthy 24-year-old man who attended the Emergency Department with fever, productive cough, and ARF requiring mechanical ventilation for bilateral pulmonary infiltrates. Cardiovascular examination on admission was unremarkable: there was no audible cardiac murmur and no peripheral stigmata of IE. Blood cultures subsequently yielded Staphylococcus aureus. Following initial extubation on day 4, the patient deteriorated rapidly within 12 hours, necessitating reintubation. The emergence of a new diastolic murmur prompted urgent echocardiography, revealing large mobile vegetations on both the aortic and mitral valves with severe regurgitation of each, consistent with left-sided IE. Definite IE was confirmed by two major modified Duke criteria. Emergency double mechanical valve replacement was performed on day 6, with the patient discharged on day 14 on lifelong anticoagulation. This case illustrates that acute severe valvular regurgitation in IE can precipitate cardiogenic pulmonary edema closely mimicking acute respiratory distress syndrome (ARDS). Concomitant aortic and mitral valve involvement likely resulted from contiguous spread via the aorto-mitral curtain. Crucially, the absence of a murmur or peripheral stigmata of IE on initial examination did not exclude the diagnosis. Early echocardiographic evaluation in unexplained ARF is paramount, particularly in the context of staphylococcal bacteremia.

Complete atrioventricular septal defect (AVSD) is rarely reported in horses. We retrospectively reviewed three Thoroughbred foals (2017-2023) with necropsy-confirmed complete AVSD and summarized their clinical presentation, transthoracic echocardiographic findings, and postmortem anatomy. All foals showed early signs of congenital cardiac disease including weakness, failure to thrive and cardiac murmurs. Echocardiography demonstrated a common atrioventricular junction with a single atrioventricular valve and combined atrial and ventricular septal defects; all were classified as Rastelli type C. Postmortem examination confirmed a common atrioventricular valve with atrial and ventricular septal components in each foal. Despite variable age at presentation, all foals had marked cardiovascular compromise and prognosis was poor. Complete AVSD should be considered in foals with early-onset debilitation or murmurs, and transthoracic echocardiography provides a reliable antemortem diagnosis.

Papillary fibroelastoma (PFE) is a benign primary cardiac tumor arising from the endocardial surface, most commonly affecting the valvular endocardium. Although often incidental, PFEs may lead to serious complications, including systemic embolization, valvular obstruction, or regurgitation. Aortic valve fibroelastoma resulting in severe aortic insufficiency (AI) may be rare. A 77-year-old woman with a history of hypertension and chronic kidney disease presented with progressive dyspnea, orthopnea, and bilateral lower extremity edema. Examination revealed a diastolic murmur at the left lower sternal border. Transthoracic echocardiography demonstrated a tri-leaflet aortic valve with preserved left ventricular systolic function and moderate eccentric aortic regurgitation due to incomplete cusp coaptation. A transesophageal echocardiogram was performed, which revealed a small, filamentous, and mobile mass that was visualized at the base of the noncoronary cusp (NCC), consistent with a PFE. There were no clinical or laboratory findings suggestive of infection, and the lesion's morphology was inconsistent with vegetation. Holodiastolic flow reversal in the descending aorta confirmed severe AI. The patient was diagnosed with acute decompensated heart failure secondary to severe aortic regurgitation. After medical optimization, she underwent surgical aortic valve replacement. Intraoperative histopathology confirmed the presence of a fibroelastoma originating from the NCC. Postoperative recovery was uneventful, and the patient demonstrated marked symptomatic improvement. This case illustrates a rare presentation of PFE causing severe aortic regurgitation through mechanical interference with cusp closure rather than leaflet destruction. PFEs are typically small, avascular, and pedunculated, and when located near the coaptation zone, they can prevent complete leaflet closure, resulting in significant hemodynamic compromise. Echocardiography remains the diagnostic modality of choice, and multimodal imaging may aid in differentiating PFEs from vegetations or thrombi. Surgical excision is recommended for symptomatic, mobile, or left-sided PFEs due to the risk of embolization and valvular dysfunction. Although rare, PFE of the aortic valve should be recognized as a potential cause of severe AI. Early diagnosis and timely surgical management are curative and prevent embolic complications.

Unicuspid aortic valves (UAVs) are rare congenital anomalies associated with severe aortic stenosis (AS) in infancy or later adulthood. This is a case of a 22-year-old woman who presented with acute hypoxemic respiratory failure, which was initially attributed to multilobular pneumonia with acute respiratory distress syndrome. However, echocardiography revealed UAV with severe stenosis, suggesting cardiogenic pulmonary edema. The patient underwent successful surgical aortic valve replacement. This case highlights that the diagnosis and management of UAVs is tenuous: cases are prone to rapid decompensation, such as flash pulmonary edema, with acute hemodynamic changes, such as aggressive intravenous fluid administration. There currently exist no guidelines specific to UAVs, but diagnosis and management can be extrapolated from bicuspid aortic valves presenting with severe stenosis. Congenital valvulopathies should be considered in young adults with a heart murmur accompanied by exercise intolerance. Complex pre-existing cardiopulmonary hemodynamics necessitate a holistic approach to the management of acute conditions like pulmonary edema in this cohort.

Background and Objectives: Acute respiratory distress syndrome (ARDS) carries high mortality, with cardiovascular complications frequently contributing to adverse outcomes. This study investigated the relationship between cardiac auscultation using electronic stethoscopy and echocardiographic findings and evaluated their prognostic significance in mechanically ventilated ARDS patients. Materials and Methods: This prospective observational study enrolled 173 consecutive adults with ARDS requiring mechanical ventilation (June 2020-June 2021). Cardiac auscultation was performed using an electronic stethoscope at four standard valvular positions. Bedside echocardiography assessed ventricular function, valvular regurgitation, right ventricular systolic pressure (RVSP), and inferior vena cava dimensions. Primary outcomes were ICU and 90-day mortality; the secondary outcome was ICU length of stay. Results: ICU mortality was 42.2% and 90-day mortality 46.8%. Auscultation findings correlated significantly with echocardiographic parameters: aortic stenosis murmur with an elevated aortic valve velocity (p = 0.009), and mitral/tricuspid regurgitation murmurs with corresponding color Doppler findings (p < 0.001). In multivariate analysis, the mean daily SOFA score (OR 2.39, 95% CI 1.57-3.64, p < 0.001) and RVSP (OR 1.07, 95% CI 1.02-1.11, p = 0.006) independently predicted ICU mortality. For 90-day mortality, the APACHE II score (OR 1.25, p = 0.006), mean daily SOFA score (OR 1.54, p = 0.039), RVSP (OR 1.07, p = 0.020), and mitral regurgitation severity (OR 2.98, p = 0.031) were independent predictors. ICU length of stay was predicted by the mean daily SOFA score (r = 0.35, p < 0.001) and tricuspid regurgitation severity (r = 0.25, p = 0.012). Conclusions: Electronic stethoscope auscultation correlates with the echocardiographic findings in ARDS patients. The RVSP and SOFA scores independently predict mortality, while valvular regurgitation severity provides additional prognostic information for long-term survival and ICU resource utilization.