A 65-year-old man develops acute pulmonary edema and a new holosystolic murmur at the apex radiating to the axilla on day 3 after an acute inferior STEMI. Which complication of myocardial infarction best explains these findings?

• A Ventricular septal rupture
• B Mural thrombus formation
• C Left ventricular free wall rupture
• D Papillary muscle rupture ✓

Explanation

Papillary muscle rupture causes acute severe mitral regurgitation, producing a holosystolic murmur at the apex radiating to the axilla and flash pulmonary edema. Ventricular septal rupture produces a harsh holosystolic murmur at the left sternal border with a thrill, not apical radiation. Free wall rupture causes tamponade, not a murmur. Mural thrombus does not cause acute murmurs.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.