Abstract
Background
Ventricular septal rupture (VSR) is a rare but life-threatening complication of ST-elevation
myocardial infarction. Point-of-care ultrasound (POCUS) is a rapid, noninvasive imaging
modality that is easily accessible and highly effective in diagnosing VSR in the emergency
department (ED) setting.
Case Report
A 73-year-old man with a history of type II diabetes mellitus and hypertension presented
with complaints of intermittent chest pain for 48 h that had since become constant,
associated with diaphoresis and shortness of breath. Physical examination was notable
for shock and a new, grade V/VI systolic murmur. An electrocardiogram showed evidence
of an inferior ST-elevation myocardial infarction (MI) with associated Q waves. POCUS
revealed a large ventricular septal rupture with new ventricular septal defect and
associated left-to-right shunting.
Why Should an Emergency Physician Be Aware of This?
POCUS in the ED setting is an effective and rapid tool for elucidating the etiology
of various shock states. Emergency physicians should be aware of this particular case,
as POCUS may help identify MI-related complications, including post-myocardial infarction
VSR, that may necessitate surgical intervention as opposed to coronary reperfusion
procedures.
Keywords
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References
- Ventricular septal and free wall rupture complicating acute myocardial infarction: experience in the Multicenter Investigation of Limitation of Infarct Size.Am Heart J. 1989; 117: 809-818
- A case report: point-of-care ultrasound in the diagnosis of post-myocardial infarction ventricular septal rupture.Clin Pract Cases Emerg Med. 2020; 4: 407-410
- Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the Shock Trial Registry.J Am Coll Cardiol. 2000; 36: 1110-1116
- Perforation of the interventricular septum in myocardial infarction. A study based upon an autopsy material.Acta Med Scand. 2009; 172: 413-418
- Interventricular septal rupture complicating acute myocardial infarction: from pathophysiologic features to the role of invasive and noninvasive diagnostic modalities in current management.Am J Med. 1992; 93: 683-688
- Trends in incidence and mortality rates of ventricular septal rupture during acute myocardial infarction.Am J Cardiol. 2010; 106: 1095-1100
- Acute postinfarction septal rupture: long-term results.Ann Thorac Surg. 1991; 52: 474-478
- Acquired ventricular septal defect after myocardial infarction: detection by combined two-dimensional and Doppler echocardiography.Am Heart J. 1986; 111: 427-429
- Color Doppler findings in ventricular septal dissection following myocardial infarction.Am Heart J. 1989; 117: 195-198
- Two-dimensional echocardiography and Doppler color flow mapping in the diagnosis and prognosis of ventricular septal rupture.Circulation. 1990; 8: 1775-1783
Article info
Publication history
Published online: September 14, 2022
Accepted:
September 4,
2022
Received in revised form:
August 16,
2022
Received:
May 16,
2022
Footnotes
E-Poster Presentation: American Institute of Ultrasound in Medicine (AIUM) Conference 2022. Presenter: Catherine Kirbos, MD; March 13, 2022; San Diego, California.
Streaming video: A brief real-time video clip that accompanies this article is available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clip 1.
Identification
Copyright
Published by Elsevier Inc.