Cardiac #4

Clinical Data: A 53-year-old patient with myocardial infarction (STEMI) and cardiac decompensation (Pulmonary-to-systemic flow ratio Qp:Qs of 3.9)

What is the most likely diagnosis?

What is the most diagnosis?

Post-myocardial infarction ventricular septal defect/rupture (VSD/VSR).


Ventricular septal defect/rupture is a rare but life-threatening complication after myocardial infarction. Generally, patients with VSR present with a transmural infarction. The defect results in left-to-right shunting and right ventricular pressure and volume overload. The rupture site can expand abruptly, resulting in sudden hemodynamic collapse in previously stable patients. Surgical closure is the definitive treatment for post-infarction VSD; however, the optimal timing of surgery remains controversial. Percutaneous closure devices have also been applied with success.


– Crenshaw BS, Granger CB, Birnbaum Y, et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation 2000;101:27-32.
– Menon V, Webb JG, Hillis LD, et al. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? J Am Coll Cardiol 2000;36:1110-6.
– O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA,
Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Jan 29;61(4):e78-e140. doi: 10.1016/j.jacc.2012.11.019. Epub 2012 Dec 17. PMID: 23256914.

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