nbme 7 q help - cinnamoncrunch

[ArchivalUser]

68M is brought to the ER 1 hour after the onset of nausea, sweating, and substernal chest pain radiating to his left arm. An ECG shows ST-segment elevation in precordial leads V1 through V4. Twenty minutes after arrival, the patient suddenly develops shortness of breath and diaphoresis. His temp is 98.6, pulse is 80, respirations are 28, and BP is 110/70. Pulse oximetry on room air shows an oxygen saturation of 89%. Cardiac examination shows a regular rhythm. A grade 2/6 holosystolic murmur is heard best at the apex with the patient in the left lateral decubitus position. Which of the following is the most likely cause of this patient™s shortness of breath?
(a) aortic dissection
(b) aortic stenosis
© atrial fibrillation
(d) cardiac tamponade
(e) mitral regurgitation
(f) pericarditis
(g) VSD

i think the answer is MR, but why can't it be VSD..the oxygen sat is low?

[ArchivalUser]

vsd murmur location is LL sternal border.

A grade 2/6 holosystolic murmur is heard best at the apex with the patient in the left lateral decubitus position..is classic for MR

[ArchivalUser]

the clue is the murmur in VSD the murmur is heard at tricuspid(left sternal border)area

[ArchivalUser]

but this guys is 68 yo..so that is why im thinking more MR

[ArchivalUser]

thanks guys!

[ArchivalUser]

vsd may occur at 68 due to complication of MI(rupture of interventricular septum, commonly after 3 days of MI)