[Acute myocardial infarction complicated by interventricular septal rupture and left ventricular thrombus]

We present the case of a 76-year-old woman, with a history of smoking and dyslipidemia, who was admitted with acute heart failure associated with a holosystolic murmur. The electrocardiogram showed an anterior ST-segment elevation myocardial infarction, and transthoracic echocardiography revealed an apical ventricular septal defect. An intra-aortic balloon pump was inserted for hemodynamic support prior to coronary angiography, which revealed occlusion of the left anterior descending artery and multivessel disease. Septal repair and coronary revascularization were subsequently performed. During the procedure, an intraventricular thrombus was identified. The postoperative course was satisfactory. On follow-up, cardiac magnetic resonance imaging confirmed persistence of an apical thrombus, and prolonged anticoagulation with rivaroxaban was indicated. This case highlights the importance of early diagnosis with echocardiography, the role of cardiac magnetic resonance imaging in thrombus detection, and the need for a multidisciplinary approach in the management of mechanical complications of acute myocardial infarction.