When the heart is torn apart: Dual rupture after acute myocardial infarction

Post-infarction mechanical complications, including ventricular septal rupture and right ventricular free-wall rupture, are rare but fatal. Early recognition is critical to improve outcomes. A 95-year-old man with pulmonary fibrosis experienced chest pain three days before hospitalization. On admission, he had inferior STEMI with second-degree atrioventricular block, outside the reperfusion window. The next day, he developed recurrent chest pain and hemodynamic shock. Transthoracic echocardiography revealed a muscular inferno-septal ventricular septal rupture (VSR) combined with right ventricular free-wall rupture (RVFWR). The coexistence of VSR and RVFWR is exceedingly rare and carries high mortality, highlighting the importance of early multimodality imaging and prompt diagnosis.