Post-myocardial Infarction Associated Ventricular Septal Defect in an Older Female

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Ventricular septal defect (VSD) is an uncommon but serious complication post-myocardial infarction (MI).
• Delayed percutaneous coronary intervention (PCI) increases the risk of VSD development, typically between 2 days and 2 weeks after MI.

Discussion:

• A case of a 91-year-old woman with prior PCI complications presented with symptoms concerning for stent thrombosis after NSTEMI.
• Despite medical management and DNR/DNI status, she developed a new VSD and died, underscoring the importance of timely PCI.
• VSD should be considered in STEMI cases with new murmurs, particularly when PCI is delayed or medical management is chosen.

Key Insights:

• Timely PCI is critical in preventing severe post-MI complications like VSD.
• VSD can occur late in STEMI patients managed medically without timely revascularization.
• Prompt diagnosis and intervention are vital for managing post-MI complications.

Outlook:

• Further research into optimal timing and strategies for PCI in complex MI cases is warranted.
• Improved patient selection and risk stratification may help prevent VSD in high-risk MI patients.
• Continued vigilance for VSD in STEMI patients, even with prior interventions, is essential.