Ventricular Septal Rupture Secondary to Inferior Myocardial Infarction
Ventricular septal rupture (VSR) is a rare and life-threatening complication of acute myocardial
infarction (AMI). The advanced age, female sex, stroke history, chronic kidney disease (CKD)
and heart failure are the independent risk factors for rupture in patients presenting with AMI.
VSR is usually concomitant with the conditions such as ST-segment elevation, initially positive
cardiac biomarkers, cardiogenic shock, high Killip class, excessive time spent till ballooning
or thrombolytic application.
Rupture develops in any anatomical locations of the ventricular
septum and at similar frequencies after anterior, inferior and lateral transmural infarctions.1
Anterior infarction tends to lead apical defects, whereas inferior or lateral infarctions lead more
frequently to defects in posterior wall or basal septum.
A 66-year-old male patient complaining of epigastric pain starting the night before was brought
to the emergency room by his relatives. The patient’s medical and family history did not feature
anything but hypertension for ten years.
His vital signs were as follows: pulse rhythmically
120/min, arterial blood pressure 100/60 mmHg, respiratory rate 30/min, and body temperature
36.5 °C. The patient being good in general condition revealed rales in the basal lungs
in pulmonary auscultation, and 2/6 systolic murmur radiating to left axilla in cardiac auscultation.
There was no pathology in the other system examinations of the patient. The electrocardiogram
was 120/min in rate with sinus rhythm and ST-segment elevation was detected in the lead II,
III, and aVF, and ST-segment depression in the lead V1-V3, also revealing reciprocal ST-segment depression in the lead I-aVL, V4-V6 suggestive of infer posterior myocardial infarction.
Emerg Med Open J. 2017; 3(2): 27-29. doi: 10.17140/EMOJ-3-136