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New cardiac murmur after acute inferior myocardial infarction.

A 44-year-old previously healthy woman was hospitalized after she had crushing substernal chest pains that radiated to the left arm and were associated with dyspnea. Physical findings were unremarkable. No murmurs were described. Evolutionary changes of an inferior lateral myocardial infarction were confirmed by an ECG and enzyme test results. Her hospital course was uneventful, until 12 days later, when she again complained of crushing substernal chest pains of three hours' duration. This was associated with development of pulmonary edema and hypotension. A new harsh, grade 2/6 apical holosystolic decrescendo murmur was heard at the cardiac apex. New ST-T wave abnormalities were noted on an ECG. She was transferred to Northwestern Memorial Hospital, Chicago, where, in addition to the previously mentioned findings, she was now noted to have a gallop rhythm and severely diminished peripheral pulses. Treatment was started for cardiogenic shock. M-mode and two-dimensional sector scanning was performed at