Cardiovascular Medicine Q32

A 52-year-old woman is evaluated during a follow-up visit. She was discharged from the hospital 3 weeks ago following a small non–ST-elevation myocardial infarction treated with drug-eluting stent placement in the right coronary artery. An echocardiogram obtained during hospitalization showed normal left ventricular function and normal valvular function. Her hospital course was uncomplicated. Since discharge, she has had shortness of breath. Medical history is significant for hyperlipidemia. Medications are aspirin, ticagrelor, lisinopril, metoprolol, and atorvastatin.

On physical examination, vital signs are normal. Oxygen saturation is 99% breathing ambient air. The estimated central venous pressure is normal. Cardiac examination reveals no S3 or murmurs. The lungs are clear to auscultation.

A chest radiograph is normal. An electrocardiogram is unchanged from those obtained in the hospital.

Which of the following is the most likely cause of this patient's dyspnea?

Ventricular septal rupture

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