A new post-MI pansystolic murmur with giant V waves on PCW tracing is almost always consistent with severe mitral regurgitation. Two possible mechanisms in this setting are papillary muscle rupture and ischemic mitral regurgitation. In a clinically deteriorating patient, the presence of a pansystolic murmur and giant V waves on PCW tracing should prompt the clinician to obtain a 2-D echocardiogram, which is the diagnostic test of choice in this setting. Cardiac tamponade and ventricular free wall rupture commonly present with hypotension and equalization of pressures but are unlikely causes of these findings.5 Ventricular septal rupture is described above.
- Severe mitral regurgitation.
5. Tschopp D, Mukherjee D. Complications of myocardial infarction. In: Griffin BP, Topol EJ, editors. Manual of cardiovascular medicine. Philadelphia: Lippincott Williams & Wilkins; 2004:45-63.
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