Acute heart failure with new-onset continuous murmur in a 26-year-old man

Clinical introduction A 26-year-old man with an unremarkable medical history sensed a momentary retrosternal ‘pop’ followed by overwhelming dyspnoea, without reporting any prodromal symptoms. At the emergency department, he had a significant tachycardia (170 bpm) and an extreme low diastolic blood pressure ( Supplementary file 3Supplementary file 4 Question What congenital cardiac anomaly did the patient have? Congenital bicuspid aortic valve Doubly committed subarterial ventricular septal defect (VSD) Congenital sinus of Valsalva aneurysm Coronary arteriovenous fistula