Abstract
A 29-year–old man presented to the emergency department with chest pain, dyspnea, and 4 episodes of nonexertional syncope, with the last episode being witnessed by emergency physicians. He had congenital aortic stenosis and a mechanical aortic valve and was anticoagulated. Two weeks prior, he had undergone repair of a right ventricular defect and pulmonic valve replacement. On examination, his blood pressure was 74/47 mmHg, his pulse rate was 130 beats/min with diminished peripheral pulses, and his respiratory rate was 40 breaths/min while speaking in full sentences.
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