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Woman with epigastric pain and dyspnoea
  1. Ryohei Ono,
  2. Sho Okada,
  3. Yoshio Kobayashi
  1. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
  1. Correspondence to Dr Ryohei Ono, Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; ryohei_ono_0820{at}

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Clinical introduction

An 85-year-old woman with no known coronary risk factors presented to the ED with a 5-day history of epigastric pain and sudden onset of dyspnoea. Her vital signs on arrival were unstable. Her BP was 68/38 mm Hg, and heart rate was 120 beats per minute. Physical examination revealed a harsh holosystolic murmur at the left sternal border and no peripheral oedema. The ECG (figure 1) and transthoracic echocardiography (figure 2, online supplemental video 1) were performed.

Supplementary video

Figure 1

Initial ECG.

Figure 2

Transthoracic echocardiography. LA, left atrium; LV, left ventricle; RV, right ventricle).


What is the likely diagnosis?

  1. Left ventricular free-wall rupture.

  2. Ventricular septal rupture.

  3. Papillary muscle rupture.

  4. Pseudoaneurysm.


Answer: B. Ventricular septal rupture (VSR) …

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  • Contributors RO contributed to patient management, conception and design of case report; acquisition, analysis and interpretation of data; and drafting the article. SO and YK contributed to interpretation of data and revising the article critically. All authors gave final approval of the article and have agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.