A 78-year-old female presents to the ED with weakness and shortness of breath. The “indigestion” she has been having for 1 week is getting better. She is afebrile, with a heart rate of 120 beats per minute, respirations 26 per minute and blood pressure 80/40 mm Hg. Her physical examination reveals rales on lung examination and a loud V/VI holosystolic murmur at the left lower sternal border radiating throughout the precordium. Chest X-ray reveals pulmonary edema. Her ECG is below:
Coronary angiography is done emergently, and her right coronary artery is completely occluded. Right heart catheterization shows normal V waves in the pulmonary capillary wedge pressure tracing. The oxygen saturation measured in the right atrium was 65%, in the right ventricle 88% and in the pulmonary artery 88%. The right atrial pressure is 20, right ventricle pressure 50/10 and pulmonary artery pressure 42/12.
What is the correct diagnosis?
A. Acute ventricular septal defect
B. Acute left ventricular free wall rupture
C. Acute mitral valve regurgitation
D. Right ventricular infarction