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A 74-year-old woman who was a current smoker was admitted with anterior ST-elevation myocardial infarction. A loud pansystolic murmur was audible at the left sternal edge and a small apical ventricular septal defect (VSD) was identified by echocardiography (ECHO). The patient had a single left anterior descending artery stenosis demonstrated at coronary angiography. The apical VSD was surgically closed with a …