ABSTRACT
Post myocardial ventricular septal rupture (VSR) is one of the most fatal complications of acute myocardial infarction (AMI) in spite of percutaneous and surgical closure. With the advancement of percutaneous coronary interventions in a timely manner, incidence of post MI VSR has declined remarkably. However, the COVID-19) pandemic-related late hospital presentations with AMI increases the possibilities of a potential upward shift in the incidence of post MI VSR. This case report aimed to increase awareness of negative contributions of the current pandemic to AMI and its fatal complications.
Subject(s)
COVID-19 , Myocardial Infarction , Ventricular Septal Rupture , COVID-19/complications , Fear , Humans , Myocardial Infarction/complications , Shock, Cardiogenic/complications , Ventricular Septal Rupture/diagnostic imaging , Ventricular Septal Rupture/etiology , Ventricular Septal Rupture/surgeryABSTRACT
During the coronavirus disease 2019 (COVID-19) pandmic, more patients are presenting with complications late after acute myocardial infarction. We report the case of a 71-year-old man who delayed seeking medical care for 2 weeks, despite progressive shortness of breath, cough, and tactile fever, for fear of contracting COVID-19 in the hospital. Clinical and echocardiographic evaluation revealed a ventricular septal rupture secondary to acute myocardial infarction. The patient underwent urgent cardiac catheterization, followed by successful saphenous vein grafting to the left anterior descending coronary artery and open surgical repair of the ventricular septal rupture with a bovine pericardial patch. This case highlights a potential long-lasting negative effect that the COVID-19 pandemic will have on the care-seeking behavior and health of patients with acute cardiovascular disease.
Subject(s)
COVID-19 , Cardiac Catheterization/methods , Coronary Artery Bypass/methods , Fear , Patient Acceptance of Health Care/psychology , ST Elevation Myocardial Infarction , Ventricular Septal Rupture , Aged , COVID-19/epidemiology , COVID-19/psychology , Coronary Angiography/methods , Echocardiography/methods , Electrocardiography/methods , Humans , Male , SARS-CoV-2 , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/surgery , Time-to-Treatment/trends , Treatment Outcome , Ventricular Septal Rupture/diagnosis , Ventricular Septal Rupture/etiology , Ventricular Septal Rupture/physiopathology , Ventricular Septal Rupture/surgeryABSTRACT
The COVID 19 pandemic resulted in a total reduction in the number of hospitalizations for acute coronary syndromes. A consequence of the delay in coronary revascularization has been the resurgence of structural complications of myocardial infarctions. Ventricular septal rupture (VSR) complicating late presenting acute myocardial infarction (AMI) is associated with high mortality despite advances in both surgical repair and perioperative management. Current data suggests a declining mortality with delay in VSR repair; however, these patients may develop cardiogenic shock while waiting for surgery. Available options are limited for patients with VSR who develop right ventricular failure and cardiogenic shock. The survival rate is very low in patients with cardiogenic shock undergoing surgical or percutaneous VSR repair. In this study we present two late presenting ST elevation MI patients who were complicated by rapidly declining hemodynamics and impending organ failure. Both patients were bridged with venoarterial extracorporeal membrane oxygenation (ECMO) to cardiac transplant.