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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.
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