Case presentation A 40-year-old male patient sought emergency care due to intensification of chronic epigastric pain on moderate exertion, without irradiation, and unrelated to food. On physical examination, vitals, blood pressure 129/81 mmHg, pulse rate 88 beats per minute, respiratory rate 20 breaths per minute, oxygen saturation 98%. He presented significant bilateral jugular distension (), irregular heart rhythm, and midsystolic click at the low left sternal border, pulmonary auscultation had vesicular murmurs present bilaterally without other adventitious sounds, flaccid abdomen, […]