An 18-yr-old male involved in a motor vehicle accident developed acute traumatic mitral regurgitation with fulminant pulmonary edema and death. He had prominent V waves on his pulmonary arterial trace, a history of chest trauma, frothy pink pulmonary edema, and elevated pulmonary artery, wedge, and CVP. His ECG was normal and physical exam was negative for a typical murmur. He was on a ventilator and had copious secretions, making the diagnosis of a murmur difficult. A high index of suspicion is necessary when any patient is admitted with a history of chest trauma so that the diagnosis of a ruptured mitral valve is not missed.