April Freije, a 6 year old Friesan mare, presented to the CUHA on 3/9/06. Prior history included trauma, pregnancy, weight loss, and ventral edema. Initial physical exam revealed signs of right and left heart failure and trauma wounds to the right forelimb. An echocardiogram found mitral, tricuspid, and aortic valve regurgitation causing congestive heart failure. In addition, a ruptured chordae tendinae was noted. It was concluded that her congestive heart failure had decompensated after the added stress of atrial fibrillation, pregnancy, blood loss from trauma, and ruptured chordae tendinae. The treatment goal was to maintain her until foaling. She improved over the course of her stay, but was euthanized due to financial constraints. Necropsy confirmed echocardiogram findings and noted an aortic aneurysm. It also revealed a twin pregnancy and secondary changes in the lungs and liver consistent with chronic heart failure.