HomeClinicalHolosystolic murmur after myocardial infarction

Holosystolic murmur after myocardial infarction

Author: Jean-François Paul, MD, Plessis-Robinson, France
Body Region: Cardiovascular

1. Patient presentation
2. CT Images
3. CT Findings
4. Diagnosis
5. References

1. Patient presentation

  • A 46-year-old man had an acute inferior myocardial infarction after physical exercise.
  • There was no evidence of heart failure. Electrocardiography showed a 3-mm ST-T segment
    elevation with Q waves in leads D2, D3, and VF and a 3-mm depression in leads V2-V4.
  • Immediate coronary angiography evidenced a tight stenosis with distal slow flow in the right
    coronary artery. Percutaneous transluminal coronary angioplasty, with implantation of 2 stents, was
    successfully performed and normal flow was restored. Post-procedure electrocardiography showed an
    isoelectric ST-T segment in leads D2, D3, and VF.
  • Maximal creatine kinase elevation was 500 IU, 12 hours after the onset of clinical symptoms.
    Subsequent cardiac auscultation uncovered a loud holosystolic murmur.
  • Color-coded Doppler echocardiography demonstrated a ventricular septal defect with a
    left-to-right shunt.
  • ECG-gated contrast-enhanced 16-slice CT was performed for further evaluation.