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March 15, 1965

Systolic Murmur Developing After Myocardial Ischemia or InfarctionDifferential Diagnosis

JAMA. 1965;191(11):888-892. doi:10.1001/jama.1965.03080110012002

A systolic murmur is sometimes heard for the first time after an episode of myocardial ischemia or the occurrence of a myocardial infarction. This murmur may be due to the rupture of a papillary muscle, the rupture of the interventricular septum, papillary muscle dysfunction, or acute left ventricular dilatation. Now that corrective surgery is theoretically possible for the first two conditions, a precise functional and anatomical diagnosis should be made in patients who develop such a murmur so that the most effective long-term therapy may be instituted. Certain features of the history and physical examination help in the differential diagnosis. However, frequently it is necessary to resort to cardiac catheterization and cinefluorography to establish the correct diagnosis.