Ventricular Septal Defect Posterior to Acute Myocardial Infarction

Abstract : We present the case of an 84-year-old woman who arrived at our unit with chest pain of cardiac origin, a Wellens type A pattern on the electrocardiogram, and on physical examination, a holosystolic murmur at the tricuspid and mitral areas radiating to the right parasternal border—a finding suggestive of ventricular septal defect. She was admitted to the Coronary Care Unit for continuous monitoring. Transthoracic echocardiography revealed rupture of the interventricular septum, along with an image compatible with a dissecting interventricular hematoma. These findings confirmed the presence of a left-to-right shunt. This case highlights the essential role of echocardiography in the early detection of mechanical complications following acute myocardial infarction, and underscores the complexity of managing post-infarction septal rupture in elderly patients.