Post-infarction ventricular septal defect

Case contributed by Dr Allam Harfoush

Presentation

Chest pain, shortness of breath, nausea, diaphoresis and palpitations.

Patient Data

Age: 70 years
Gender: Male
Ultrasound

Echocardiography

This footage represents an abrupt interruption within the normal myocardium of the interventricular septum. Color Doppler shows flow between the left and the right ventricle.

Ultrasound images show a 7 mm Left/Right muscular VSD. Qp:Qs= 2.6

The left ventricle is mildly hypertrophied.

The left atrium is mildly dilated.

The right ventricular diameter and function are within normal.

Case Discussion

The patient presented with acute anteroseptal STEMI.

After the initiation of intravenous thrombolytic therapy, patient was stabilized with normal vital signs. Auscultation: no heart murmurs, bi-basilar lung fine crackles.

Day 3 follow-up: no chest pain, orthopnea nor paroxysmal nocturnal dyspnea.
Auscultation revealed a hollow systolic murmur.

Ventricular septal defect (VSD) is a rare but life-threatening mechanical complication of acute myocardial infarction; patients should undergo emergency surgical or percutaneous intervention to prevent hemodynamic deterioration and multi-organ failure.

It may occur within 24 h to several days after myocardial infarction and the diagnosis is confirmed by echocardiography.

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Case information

rID: 76225
Published: 19th Apr 2020
Last edited: 19th Apr 2020
System: Cardiac
Inclusion in quiz mode: Included
Institution: Tishreen University Hospital

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