Rapid Bedside Differentiation of Ruptured Interventricular Septum from Acute Mitral Insufficiency

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Abstract
THE sudden appearance during the course of acute myocardial infarction of a loud systolic murmur in association with rapid onset of pulmonary congestion or systemic hypotension (or both) is almost always due to either rupture of the interventricular septum (RIVS) or acute massive mitral regurgitation (ARM)1 resulting from severe dysfunction or rupture of a papillary muscle.2 , 3 Early emergency surgery for both RIVS and AMR is now feasible4 5 6 7 8 9 10 11 and indeed may be the only alternative when the patient's condition is deteriorating despite maximum medical therapy. Although certain clinical features – for example the presence or absence of a precordial thrill or . . .