Report on Rare Complication Post Silent Myocardial Infarction: Ventricular Septal Rupture

The advent of primary reperfusion therapy for the treatment of myocardial infarction (MI) has made mechanical complications rare. Mechanical complications include free wall rupture, papillary muscle rupture, left ventricular septal rupture, and more. In this case, we describe a 53-year-old patient who presented to the emergency department with complaints of shortness of breath, abdominal pain, urinary retention, and constipation. On exam, he was in mild distress and presented with jugular venous distension (JVD), bibasilar crackles, and diffuse abdominal pain with guarding. After a rapid hemodynamic decline and a transthoracic echocardiogram that displayed a new onset ventricular septal defect (VSD), it was determined that the patient had a ventricular septal rupture (VSR). Septal rupture is a cardiac emergency causing cardiogenic shock and carries a high mortality risk despite prompt surgical treatment; hence a high suspicion is warranted. Our patient presented with generalized symptoms, no previous cardiovascular history, and no reported myocardial infarctions or risk factors, leading to a low clinical index of suspicion for a VSR. This case highlights the importance of high clinical suspicion of ventricular septal rupture in a patient presenting with similar symptoms so prompt management can occur.