The sudden development of a harsh apical systolic murmur in a patient with a recent myocardial infarct is usually considered to indicate rupture of a papillary muscle or perforation of the interventricular septum.1,2 the differential diagnosis of a loud precordial systolic murmur of sudden onset may be difficult and to describe a syndrome whereby such a murmur may occur secondary to mechanical dysfunction of a papillary muscle.
—An 85-year-old white male, previously in good health, was admitted to hospital with severe crushing substernal pain which he had had for several hours. His blood pressure was 135/75 mm Hg, and his pulse rate was 88 per minute and regular. The lungs were clear on auscultation. The heart was not enlarged, and there were no murmurs or gallop sounds. The electrocardiogram on admission showed an acute anteroseptal myocardial infarct. The serum glutamic oxaloacetic transaminase (SGOT) was 165