Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Cardiology

Answer 3
  1. 2-D echocardiography with Doppler. The two most common causes of a pansystolic murmur after an acute MI are ventricular septal or papillary muscle rupture. A number of modalities can be used to differentiate these two conditions; however, 2-D echocardiography with Doppler is the best first test. Right heart catheterization is also helpful in diagnosing a ventricular septal rupture by demonstrating a stepped-up oxygen saturation in the right ventricle and pulmonary artery. A shunt fraction can also be calculated. Chest radiograph and computed tomography are not very helpful in identifying the cause and mechanism of the pansystolic murmur post-acute MI. Transesophageal echocardiography is an important modality and is commonly performed; however, it should not be the first test.
Click here to return to the questions
 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj