History:

A 69 year old female presents with several hours of substernal chest pain.

Physical Examination:

Blood pressure is 133/75, pulse is 99 bpm. there is an S4 murmur. Patient is treated for acute myocardial infarction. On the third day of her hospital stay, she reports respiratory difficulty to the nurse that is on duty. Blood pressure has lowered to 88/40, pulse is tachycardic at 158 bpm. There is no pulsus paradoxus nor jugular venous distention. there is a systolic thrill palpable at the lower left sternal border with a V/VI systolic murmur radiating along the left sternal border. EKG demonstrates no new new findings from initial admission.

Based on the ladies findings and no previous Q wave findings on her initial EKG, I will take a stab at her having a ventricular septal defect. She will more than likely need to have an echocardiogram performed to substantiate the defect’s location and size.

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