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Updated: Oct 13, 2025
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Heartbreak: A case of post-infarction cardiogenic shock
1Department of Emergency Medicine Armadale Hospital Armadale Western Australia Australia.
Insights
Ventricular septal rupture after heart attack is deadly. Prompt diagnosis via echocardiography by emergency physicians is crucial for timely surgical intervention and improved survival.
Area of Science:
- Cardiology
- Emergency Medicine
- Medical Imaging
Background:
- Ventricular septal rupture (VSR) is a rare, life-threatening complication of acute myocardial infarction (MI).
- Despite advances like percutaneous coronary intervention, mortality rates for VSR remain high.
- Rapid diagnosis and surgical intervention are critical components of the chain of survival for VSR.
Observation:
- Echocardiography is central to diagnosing VSR and guiding treatment.
- This case highlights the successful diagnosis of VSR by an emergency physician using echocardiography in an Australian emergency department.
- Proficiency in basic echocardiography for emergency physicians is essential for rapid VSR diagnosis.
Findings:
- Prompt echocardiography by emergency physicians can definitively diagnose VSR.
- Medical management alone is generally futile; afterload reduction or mechanical support may be used temporarily.
- Multidisciplinary collaboration is vital for planning optimal surgical timing post-diagnosis.
Implications:
- Emergency physicians skilled in echocardiography can significantly expedite VSR diagnosis.
- Early diagnosis facilitates critical, timely surgical intervention, potentially reducing mortality.
- Integrated, case-tailored discussions among emergency medicine, cardiology, cardiothoracic surgery, and intensive care teams are paramount for effective VSR management.
Abstract:
Ventricular septal rupture is a rare but catastrophic complication of acute myocardial infarction. Although it has declined in incidence since the introduction of percutaneous coronary intervention, there hasn't been a significant change of mortality from the condition. In the chain of survival, prompt diagnosis and definitive surgery form the cardinal links. Prolonged medical management is not a feasible option as it is likely to be futile but the aim should be to reduce afterload with the help of intra-aortic balloon pump or support with ventricular assist devices. Echocardiography sits at the heart of the diagnosis of this time critical condition and will guide accurate therapy and intervention. We present the first reported case from an Australian emergency department, where the echocardiography done by the emergency physician clinched the diagnosis. We emphasise here the paramountcy of emergency physicians being proficient in basic echocardiography to achieve rapid diagnosis. Once diagnosed it is critical to have an individual case-tailored multi-disciplinary discussion between emergency medicine, cardiothoracic surgery, cardiology and intensive care as to plan the optimal timing of surgery.
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