DOI: 10.5811/westjem.2012.5.12594

A 63-year-old female with pulmonary hypertension presented to the emergency department (ED) with hemoptysis. Vital signs were significant for tachypnea, with respirations of 30 per minute, and hypoxia, with an oxygen saturation of 88%. Physical examination revealed a systolic cardiac murmur. Bedside emergency ultrasound (EUS) demonstrated a right ventricle that appeared to be enlarged in relation to the left ventricle, consistent with a diagnosis of pulmonary hypertension. In addition, a ventricular septal defect (VSD) was present. Color flow doppler showed a left to right shunt through the VSD (Video). VSDs are the most common cardiac congenital defect at birth and account for 40 % of all cardiac anomalies.1 The normal directionality of blood flow across a VSD is left to right, due to the relatively higher pressure in the lef