Rosh Emergency Medicine Practice Test

What is the most likely diagnosis for a patient presenting with chest pain, dyspnea, and a holosystolic murmur after a recent myocardial infarction?

1. Acute mitral regurgitation

2. Pericarditis

3. Pulmonary embolism

4. Ventricular free wall rupture

The correct answer is: Acute mitral regurgitation

The presentation of chest pain, dyspnea, and a holosystolic murmur following a recent myocardial infarction suggests a case of acute mitral regurgitation. This condition often arises due to the rupture of the chordae tendineae or papillary muscles linked to the ischemic damage of the heart muscle caused by the myocardial infarction. The holosystolic murmur indicates that there is a significant volume of backflow of blood from the left ventricle into the left atrium during systole, a hallmark of acute mitral regurgitation. Acute mitral regurgitation can escalate very quickly, leading to rapid deterioration in the patient's condition, which is consistent with the symptoms of dyspnea and chest pain. The recent myocardial infarction indicates a high likelihood that the heart's structural integrity has been compromised, which is often the underlying cause of this acute complication. Thus, the combination of these clinical findings strongly supports acute mitral regurgitation as the most likely diagnosis. In contrast, while pericarditis can also cause chest pain and might be seen after myocardial infarction, it does not typically present with a holosystolic murmur. Pulmonary embolism can cause dyspnea and chest