When a healthy person during vigorous exercise or straining has a sudden cough and a sense of suffocation or pain in the chest with severe congestive heart failure following, the largely unsolved problem of just why heart failure occurs when it does is highlighted. In some cases the symptoms progress without improvement from treatment and death soon follows. Rupture of the aortic valve from strain is one cause for such a sequence of events. Though rare, it is easy to recognize if one keeps in mind the characteristic signs, symptoms, and clinical course. This report illustrates the salient features of the syndrome in a case in which the condition was diagnosed during life.
C. P. Howard,1 in 1928, wrote the classic paper on the rupture by strain of the aortic valve. One of us (W. B. B.) recently reviewed the subject of precordial noises heard at a distance from