ABSTRACT
A 59-year-old woman was admitted to our hospital with acute pulmonary oedema and cardiogenic shock 35â days after anterior ST elevation myocardial infarction. She developed a new loud pan systolic murmur. Echocardiography revealed a ventricular septal rupture with a significant left to right shunt. She was immediately transferred to the local cardiothoracic unit where she underwent a successful ventricular septal defect (VSD) repair. Ventricular septal rupture often presents within the first 24â hours of acute myocardial infarction and is rare thereafter. It carries a poor mortality (41-80%) even when recognised. Timely recognition of this life-threatening complication can help reduce the resultant morbidity and mortality. Doctors should be aware that this well-recognised complication may present unusually late as in this case.
Subject(s)
Anterior Wall Myocardial Infarction/complications , Ventricular Septal Rupture/etiology , Anterior Wall Myocardial Infarction/diagnosis , Coronary Angiography , Diagnosis, Differential , Echocardiography , Electrocardiography , Female , Follow-Up Studies , Humans , Middle Aged , Time Factors , Ventricular Septal Rupture/diagnosisABSTRACT
An 86-year-old lady presented with an acute inferior ST elevation myocardial infarction. The coronary angiogram showed a thrombotic occlusion of the right coronary artery, which was aspirated, but there was no underlying lesion to stent. The patient remained very hypoxic on the ward with clear lung fields and was found to also have multiple pulmonary emboli on CT pulmonary angiogram. Paradoxical embolism was suspected as the cause of myocardial infarction and subsequent echocardiography studies indeed confirmed the presence of a patent foramen ovale. Although rare, this mechanism should be considered in patients presenting with acute coronary syndromes without significant underlying coronary artery disease.