The finding of a loud pan-systolic murmur in a patient with an
acute infarction is a serious complication, requiring prompt diagnosis
and surgical treatment if the patient is to survive. The site
of maximal murmur intensity may aid auscultatory diagnosis, but
otherwise the differential diagnosis can be very difficult. This
is especially the case if an old infarction or left bundle branch
block make electrocardiographic determination of the infarction
site impossible.
Post infarction ventricular septal defect most
commonly occurs at the junction of the anterior and posterior
portions of the septum, usually near the apex. It is frequently
difficult to visualize on any single view. While visualization
of the actual defect may be difficult, it may strongly be suspected
by a severe wall-motion abnormality in the distal septum. Now
that Doppler echocardiography is available, the presence of a
post infarction ventricular septal defect may be confirmed with
certainty.
2004