A 60-year-old man with anterior STEMI undergoes primary PCI successfully. Two days later, he develops new harsh holosystolic murmur at the left sternal border with thrill, and acute pulmonary edema. Echocardiography is most likely to show:
- A Ventricular septal rupture (acquired VSD) ✓
- B Papillary muscle rupture with mitral regurgitation
- C Free wall rupture with tamponade
- D Acute severe aortic regurgitation
Correct answer: A. Ventricular septal rupture (acquired VSD)
Explanation
Post-MI ventricular septal rupture (acquired VSD) classically presents 3–5 days after anterior MI with a new harsh holosystolic murmur at the left sternal border, palpable thrill, and step-up in oxygen saturation from right atrium to right ventricle. It differs from papillary muscle rupture (which causes mitral regurgitation with apical murmur and no thrill at left sternal border). Free wall rupture causes sudden tamponade and death. This is a surgical emergency requiring urgent repair.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.