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[An unusual case of postinfarction ventricular septal rupture in a patient with angiographically normal coronary
Insights
Ventricular septal defect is a rare complication of acute myocardial infarction. This case highlights its occurrence in a patient with normal coronary arteries, suggesting alternative pathogenic mechanisms.
Area of Science:
- Cardiology
- Pathophysiology
Background:
- Ventricular septal defect (VSD) is a rare, life-threatening complication of acute myocardial infarction (AMI).
- VSD typically arises in patients with single-vessel coronary artery disease and occluded culprit vessels, often without collateral circulation.
Observation:
- This report details a 59-year-old female experiencing anteroseptal myocardial infarction.
- The patient developed a ventricular septal defect with congestive heart failure signs four days post-admission.
- Crucially, her coronary arteries appeared normal upon angiography.
Findings:
- The case demonstrates VSD occurring despite angiographically normal coronary arteries.
- This suggests non-atherosclerotic mechanisms, such as inflammation, hypercoagulable states, or coronary vasospasm, may underlie VSD in specific AMI cases.
Implications:
- This case expands the known spectrum of VSD pathogenesis following myocardial infarction.
- It underscores the importance of considering diverse etiological factors beyond obstructive coronary artery disease.
- Further research into non-atherosclerotic mechanisms is warranted for managing VSD post-MI.
Abstract:
Ventricular septal defect is a rare but potentially fatal complication of acute myocardial infarction. It usually occurs during the first episode of myocardial infarction, most often in patients with single vessel coronary artery disease and total occlusion of the culprit vessel, in the absence of an adequate collateral circulation. However, this complication is observed in patients with myocardial infarction with normal coronary arteries and its pathogenesis may be attributed to different mechanisms such as inflammation, hypercoagulable state or coronary vasospasm. We report the case of a 59-year-old female patient with anteroseptal myocardial infarction developed 4 days after admission, complicated by ventricular septal defect with signs of congestive heart failure and angiographically normal coronary arteries.
