Silent Myocardial Infarction Presenting With Concurrent Left Ventricular Aneurysm, Intracavitary Thrombus, and Ventricular Septal Defect: A Case Report

Mechanical complications of acute myocardial infarction (AMI) - including left ventricular aneurysm (LVA), ventricular septal defect (VSD), free wall rupture, and papillary muscle rupture - are rare in the current reperfusion era but carry high mortality. Silent myocardial infarction (MI), particularly in diabetic patients, often goes unrecognized until these complications manifest. The concurrent occurrence of multiple mechanical complications following a silent AMI is exceedingly rare and poses significant diagnostic and therapeutic challenges. We report a 70-year-old woman with diabetes mellitus who presented to the emergency department with acute pulmonary edema. Workup revealed an unrecognized prior MI complicated by a large LVA with an intracavitary thrombus and a concomitant VSD that was thrombotically occluded, thereby preventing hemodynamic shunting. The diagnosis was established through echocardiographic imaging. Management required a multidisciplinary approach involving cardiology, cardiac surgery, and critical care teams. Unfortunately, the patient died during coronary angiography due to refractory ventricular fibrillation. This case highlights the diagnostic challenge of silent MI in elderly diabetic patients and underscores the importance of early echocardiographic evaluation in unexplained heart failure. The rare coexistence of an LVA with an intracardiac thrombus and a VSD demands prompt recognition and coordinated multidisciplinary care to optimize outcomes.