Murmur in a man with acute myocardial infarction

Clinical introduction A man in his 60s with history of smoking presented to the emergency room 10 days after an epigastric pain and progressive worsening dyspnoea. Vital signs were normal. Examination revealed bibasilar crackles and a murmur in the left sternal border. ECG shows an inferior wall myocardial infarction with Q-waves and T-wave inversion. The murmur and transthoracic echocardiography image are shown in figure-video 1. Physical examination and echocardiographic findings are consistent with: acute mitral regurgitation left ventricular free-wall rupture aortic regurgitation ventricular septal rupture (VSR) Answer:D Incidence of VSR in reperfusion era is 0.31%,1 2 with a bimodal distribution, first 24 hours and then at 3–5 days.3 Independent clinical predictors are female gender, lack of previous angina, age and magnitude of ST deviation in lead III.1 Symptoms may include dyspnoea, orthopnoea and...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research