title: [A 76-year-old man with a murmur after myocardial infarction].
abstract: A 76-year-old, previously healthy man who presented with acute onset of central chest pain is described. An ECG taken in the ambulance showed ST-elevation in chest leads V1 to V4, whereupon thrombolysis was initiated before hospitalization. A new ECG taken on admission at the local hospital showed reduced ST-elevation. Shortly afterwards, auscultation followed by eccocardiography revealed a ventricular septal rupture. The patient was transferred to the regional hospital, and emergency repair of the ventricular septum was performed successfully. On the 6th postoperative day, the patient suffered septal rupture recurrence and subsequently died of multi-organ failure. Postinfarction ventricular septal rupture is a serious complication with a high mortality. Cardiac surgery is indicated in most cases. Delayed diagnosis may result in early death for a considerable number of patients. The present case underscores the importance of cardiac auscultation in patients with suspected myocardial infarction before angiography or primary coronary intervention is performed.
authors.affiliation: St. Elisabeth-Klinikk for hjerte- og lungekirurgi, St. Olavs Hospital, Hans Nissensgate 3, 7018 Trondheim. alexander.wahba@ntnu.no
authors.forename: Alexander
authors.initials: A
authors.lastname: Wahba
authors.forename: Frode
authors.initials: F
authors.lastname: Flobak
authors.forename: Tor Ivar
authors.initials: TI
authors.lastname: Stakkevold
authors.forename: Olav M
authors.initials: OM
authors.lastname: Sellevold
authors.forename: Guri
authors.initials: G
authors.lastname: Greiff
authors.forename: Rune
authors.initials: R
authors.lastname: Wiseth
mesh_terms: D000368:Aged; D004452:Echocardiography; D004562:Electrocardiography; D006326:Heart Auscultation; D006337:Heart Murmurs / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D012008:Recurrence; D018658:Ventricular Septal Rupture / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery