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.
Keywords :
Echocardiography, Elderly patient, Myocardial infarction, Ventricular septal rupture, Wellens sindrome.References :
- Crenshaw, B. S., Granger, C. B., Birnbaum, Y., Pieper, K. S., Morris, D. C., Kleiman, N. S., … & Califf, R. M. (2000). Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. Circulation, 101(1), 27–32.
- López-Sendón, J., Gurfinkel, E. P., Lopez de Sa, E., Agnelli, G., Steele, P. M., & Lopez de Sa, J. M. (2010). Diagnosis and management of mechanical complications in acute myocardial infarction. European Heart Journal, 31(24), 3057–3063.
- Ibáñez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., … & Widimsky, P. (2018). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal, 39(2), 119–177.
- Arnaoutakis, G. J., Zhao, Y., George, T. J., Sciortino, C. M., McCarthy, P. M., & Conte, J. V. (2012). Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Annals of Thoracic Surgery, 94(2), 436–444.
- Maltais, S., Ibrahim, R., Basmadjian, A. J., Carrier, M., Perrault, L. P., Bouchard, D., … & Cartier, R. (2014). Postinfarction ventricular septal rupture: towards a new treatment algorithm?. The Journal of Thoracic and Cardiovascular Surgery, 147(6), 1962–1967.
- Di Summa, M., Iacona, G. M., Crupi, G., De Bonis, M., & Glauber, M. (2021). Surgical and percutaneous management of post-infarction ventricular septal defect: current options and outcomes. Journal of Thoracic Disease, 13(9), 5337–5346.

