You are incorrect - the best diagnosis in our patient is a ventricular septal defect.


Your choice: Chronic mitral regurgitation

Typical bedside findings of chronic mitral regurgitation include an enlarged, displaced and sustained apical impulse, due to chronic left ventricular volume overload; a high frequency, holosystolic murmur at the apex, due to mitral regurgitation; and both a third heart sound and a low frequency, mid diastolic murmur at the apex, due to enhanced left ventricular filling.