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


Answer 5
  1. Severe mitral regurgitation. 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.

     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.

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