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Post Myocardial Infarction Ventricular Septal Rupture Revealed By Acute Liver Failure Symptoms: A Case Report
Leila Haddar1,2, Amine Bouchlarhem1,2, Salma Bouyaddid1,2
1Faculty of Medicine and Pharmacy, Mohammed Premier University, Oujda, Morocco.
Introduction:
The mechanical complications of acute myocardial infarction (AMI) still kill despite the evolution of medicine. Early diagnosis and adequate management are necessary to improve the prognosis, and this requires first, a good clinical examination that should raise the suspicion of a mechanical complication, then the echocardiography is performed to confirm the diagnosis.
Case Presentation:
We present a case of a 64-year-old patient admitted to the emergency room for jaundice with delayed ST-segment elevation myocardial infarction (STEMI). Physical examination revealed signs of right heart failure, which led us to associate jaundice with signs of acute liver failure secondary to right heart failure. Echocardiography confirmed the diagnosis of a ventricular septal rupture (VSR) with left-right shunt, and a significant dilation of the right ventricle. The patient underwent surgical closure of the VSR with fatal evolution.
Discussion:
VSR is a rare life-threatening mechanical complication of AMI. The clinical signs depend on the left-right shunt and the onset of heart failure, which are 2 major determinants of the therapeutic strategy and the timing of the surgery. Despite surgical closure of the VSR, the mortality remains high, but the prognosis is better in patients treated with surgery than in patients who are treated medically only.
Conclusion:
The clinical presentation of VSR may differ from a patient to another. Good clinical sense and echocardiography are essential to set early diagnosis, and thus decide on the adequate management at the right time.
Insights
Ventricular septal rupture (VSR) is a rare but deadly complication of acute myocardial infarction (AMI). Early diagnosis via clinical exam and echocardiography is crucial for timely management, though VSR still carries a high mortality rate.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Diagnostics
Background:
- Mechanical complications of acute myocardial infarction (AMI) remain a significant cause of mortality.
- Prompt diagnosis and management are critical for improving patient outcomes.
- Clinical examination and echocardiography are key diagnostic tools.
Observation:
- A 64-year-old patient presented with jaundice and ST-segment elevation myocardial infarction (STEMI).
- Physical examination revealed signs of right heart failure, correlating with jaundice and acute liver failure.
- Echocardiography confirmed ventricular septal rupture (VSR) with a left-right shunt and right ventricular dilation.
Findings:
- Ventricular septal rupture (VSR) is a rare, life-threatening mechanical complication of AMI.
- Clinical signs of VSR are influenced by the shunt and heart failure onset.
- Surgical closure of VSR, while associated with high mortality, offers a better prognosis than medical management alone.
Implications:
- VSR diagnosis requires a combination of clinical suspicion and echocardiographic confirmation.
- Timely diagnosis and appropriate management are essential for VSR patients.
- Despite advances, VSR continues to present a significant therapeutic challenge with a guarded prognosis.
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