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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.
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