Physical examination revealed a young male in moderate distress. Vital signs were: temperature, 39°C; BP, 140/95 mm Hg; heart rate, 110 beats/min; respiratory rate, 30 breaths/min; and pulse oximetric oxygen saturation, 99% while breathing room air. Neck examination revealed large-amplitude jugular venous pulsations to approximately 10 cm of water above the sternal angle with head of bed at 45°. Lung examination was clear to auscultation bilaterally. Cardiac examination was notable for a regular tachycardic rhythm without appreciable murmurs, rubs, or gallops. No stigmata of endocarditis were found on a detailed examination of the skin. Neurologic examination was unremarkable.