A 70-year-old man presents with hypotension four days following an anterior myocardial infarction. Vital signs show BP 85/52 mmHg, HR 118/min, RR 22/min, temperature 37.2°C, and SpO2 94% on room air. Physical examination reveals a new harsh holosystolic murmur best heard at the left lower sternal border. Troponin I remains elevated at 8.2 ng/mL. Chest X-ray shows mild pulmonary edema without significant cardiomegaly. He denies chest pain. Which diagnosis best explains these findings?
- A)Papillary muscle rupture
- B)Free wall rupture
- C)Ventricular septal ruptureGABARITO
- D)Ventricular aneurysm
- E)Dressler syndrome
Explicação
Ventricular septal rupture is correct. Macrophage degradation of infarcted tissue several days after MI can lead to septal perforation, creating an acute left to right shunt and a new harsh holosystolic murmur at the left sternal border. This often causes rapi... Ver explicação completa e trilha adaptativa →