Detection of Ventricular Septal Defect Complicating Acute Myocardial Infarction by Pulse Doppler Flowmeter

A 60 year old man was admitted to the CCU two or three weeks after an acute posterior myocardial infarction. On examination there was cloudy mentation, pale and cool lower extremities, hypotension, atrial fibrillation with a ranid ventricular response, a grade 4/6 pansystolic murmur and thrill at the apex, and evidence for severe biventricular failure.