A 70-year-old man 4 days post-STEMI develops a new harsh holosystolic murmur at the lower left sternal border with a palpable thrill. BP drops to 90/60 mmHg. Jugular venous pressure is elevated. Which diagnosis does this presentation indicate?
- A Ventricular septal defect (post-infarction) ✓
- B Acute mitral regurgitation due to papillary muscle rupture
- C Free wall rupture with tamponade
- D Aortic dissection
Correct answer: A. Ventricular septal defect (post-infarction)
Explanation
Post-infarction ventricular septal defect classically occurs 3–5 days after MI (more common with anterior STEMI) and presents with a new harsh holosystolic murmur at the lower left sternal border with an associated thrill, biventricular failure, and elevated JVP due to left-to-right shunt. Acute MR from papillary muscle rupture presents with a murmur best heard at the apex radiating to the axilla, and typically causes pulmonary edema without significant RV failure. Free wall rupture causes tamponade with muffled heart sounds and pulsus paradoxus.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.