As shown in Video 3, lung US (Video 1, Clip 1) showed a diffuse bilateral and severe B-line pattern, corresponding to pulmonary edema (PE). This evaluation was obtained in seconds and performed with the patient seated because he was not able to tolerate supine decubitus. The presence of normal lung sliding, absence of subpleural consolidations, and a nonpatchy distribution of B lines and orthopnea strongly suggest the diagnosis of a PE of cardiogenic origin. Parasternal long-axis view (Video 1, Clip 2) showed a hyperdinamic left ventricular systolic function, a normal aortic root and aortic valve, left ventricular posterior wall hypokinesia and a flail posterior mitral valve leaflet, which looked too long because it had attached to a thin structure corresponding to a chordae tendineae, and also a thick region compatible with a ruptured papillary muscle (PM) head. The presence of normal left ventricular size and function in the context of cardiogenic PE (drastic change in the pressure-volume relationship) should immediately raise the possibility of acute valvular regurgitation. Color Doppler US showed an MR jet that was directed anteriorly. As a general rule, when there is a flail or prolapsed leaflet, the regurgitation jet follows an opposite direction. Because of the rapid pressure equilibration between the left ventricle (LV) and the left atrium (LA) in the context of severe acute MR, the MR jet is not seen as massive, and this explains why clinically an MR murmur is subtle or is not evident on cardiac auscultation. Furthermore, because of its eccentric direction and tachycardia, the real magnitude of the MR can also be underestimated. Parasternal short-axis views at basal and midventricular levels (Video 1, Clip 3) showed a hyperdinamic left ventricular systolic function and clear inferior and posterior hypokinesia. When looking in detail, a mobile isoechoic structure was observed in the inferoposterior region, which was compatible with the flail mitral subvalvular apparatus. Right ventricle geometry looked normal. An apical four-chamber view (Video 2, Clip 4) showed hyperdinamic left ventricular systolic function and a flail posterior mitral valve leaflet, a flail chordae tendineae, and a ruptured PM head (Fig 1). An eccentric and anteriorly directed MR jet was evident on color Doppler US. Right ventricular size and function were normal. At an apical two-chamber view (Video 2, Clip 5), a hyperdinamic LV and inferior hypokinesia were also observed. In this view, a thin structure entering into the LA and attached to the posterior mitral valve leaflet was observed; this is compatible with a flail chordae tendineae (Fig 2). In a subcostal longitudinal view (Video 2, Clip 6), the inferior vena cava looked depleted and with full collapsibility; abdominal aorta was normal in size with no flap seen inside (not shown). The inferior vena cava, as observed in this case, is a real example teaching that this parameter cannot be used in an isolated manner to rule in or rule out cardiogenic PE. This is presumably explained from the large negative pleural pressure swings occurring with the patient’s breathing pattern. No pleural or pericardial effusion was noted.