20. Which of the following murmurs can be heard on physical examination in a patient with active myocardial ischemia?

A. An early diastolic decrescendo murmur

B. A systolic, late peaking crescendo-decrescendo murmur

C. An early diastolic decrescendo murmur with late diastolic accentuation

D. A holosystolic murmur at the cardiac apex radiating to the axilla

Mitral regurgitation can occur during ischemia. During inferior ischemia, posteromedial papillary muscle dysfunction can cause mitral regurgitation resulting in a holosystolic murmur at the cardiac apex radiating to the axilla (see Heart Murmurs). This rarely occurs during anterior or lateral ischemia since the anterolateral papillary muscle has dual supply from the left anterior descending and circumflex coronary artery.