A 65-year-old man with STEMI undergoes primary PCI successfully. On day 3, he develops sudden hypotension, elevated JVP, clear lung fields, and a new loud holosystolic murmur at the left sternal border that increases on inspiration. Which complication is most likely?
- A Acute mitral regurgitation due to papillary muscle rupture
- B Free wall rupture with haemopericardium
- C Ventricular septal defect (post-infarction VSD) ✓
- D Right ventricular infarction
Correct answer: C. Ventricular septal defect (post-infarction VSD)
Explanation
Post-infarction VSD typically occurs 3–5 days after MI and presents with cardiogenic shock, right heart failure (elevated JVP, no pulmonary oedema initially), and a new harsh holosystolic murmur loudest at the left sternal border that characteristically increases with inspiration (Carvallo's sign) due to increased right-sided flow. Papillary muscle rupture causes acute mitral regurgitation with pulmonary oedema. Free wall rupture typically causes haemopericardium and pulseless electrical activity.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.