Ventricular septal defect after acute myocardial infarction: an unusual but life-threatening complication
DOI:
https://doi.org/10.21615/cesmedicina.35.1.6Keywords:
Myocardial infarction, Ventricular septal defect, Heart aneurysmAbstract
Introduction: early coronary revascularization has reduced the occurrence of mechanical complications of acute myocardial infarction; ventricular septal defect (interventricular communication) usually occurs between the third and fifth days after the event. We present an unusual case where the predominant symptoms were mainly gastrointestinal.
Description: A 65-year-old male patient with a history of high blood pressure, active smoking and frequent alcohol consumption, consulted for gastrointestinal symptoms and chest pain with atypical characteristics. In the physical examination a holosystolic murmur with predominance in the foci of the base was found, the electrocardiogram documented QS in the inferior wall without alterations of the ST-T segment, positive cardiac biomarkers and the echocardiogram reported systolic dysfunction, basal and middle segment aneurysm of the lower wall, with ventricular septal defect with left to right flow. A diagnostic coronary angiography was performed founding two vessel severe disease, then the patient was surgically intervened for ventricular aneurysm correction, ventricular septal defect and coronary bypass.
Conclusion: Recognizing the atypical clinical manifestations of acute myocardial infarction and a well-performed physical examination make it possible to identify serious problems such as the mechanical complications of infarction.
Downloads
References
Ibáñez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. Guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST. Rev Esp Cardiol. 2017;70(12):1082.e1-1082.e61.
Boletín Observatorio Nacional de Salud. Enfermedad cardiovascular: principal causa de muerte en Colombia. Instituto Nacional de Salud. Boletín No. 1, Diciembre 9 de 2013.
Figueras J, Cortadellas J, Calvo F, Soler-Soler J. Relevance of delayed hospital admission on development of cardiac rupture during acute myocardial infarction: study in 225 patients with free wall, septal or papillary muscle rupture. J Am Coll Cardiol. 1998;32(1):135-9.
Moreno JQ, Rodríguez DJA, Rugeles T, López LMB. Complicaciones mecánicas del infarto agudo de miocardio: aunque infrecuentes, potencialmente letales. Rev Col Cardiol. 2017;24(5):505-9.
Prêtre R, Rickli H, Ye Q, Benedikt P, Turina MI. Frequency of collateral blood flow in the infarct-related coronary artery in rupture of the ventricular septum after acute myocardial infarction. Am J Cardiol. 2000;85(4):497-9, A10.
Kutty RS, Jones N, Moorjani N. Mechanical complications of acute myocardial infarction. Cardiol Clin. 2013;31(4):519-31, vii-viii.
Durko AP, Budde RPJ, Geleijnse ML, Kappetein AP. Recognition, assessment and management of the mechanical complications of acute myocardial infarction. Heart. 2018;104(14):1216-23.
Lemery R, Smith HC, Giuliani ER, Gersh BJ. Prognosis in rupture of the ventricular septum after acute myocardial infarction and role of early surgical intervention. Am J Cardiol. 1992;70(2):147-51.
Crenshaw BS GC, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS, et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation. 2000 101(1):27-32.
Honda S, Asaumi Y, Yamane T, Nagai T, Miyagi T, Noguchi T, et al. Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years. J Am Heart Assoc. 2014;3(5):e000984.
Jones BM, Kapadia SR, Smedira NG, Robich M, Tuzcu EM, Menon V, et al. Ventricular septal rupture complicating acute myocardial infarction: a contemporary review. Eur Heart J. 2014;35(31):2060-8.
Moreyra AE, Huang MS, Wilson AC, Deng Y, Cosgrove NM, Kostis JB, et al. Trends in incidence and mortality rates of ventricular septal rupture during acute myocardial infarction. Am J Cardiol. 2010;106:1095-100.
López-Sendón J, Gurfinkel EP, de Sa EL, Agnelli G, Gore JM, Steg PG, Eagle KA, Cantador JR, Fitzgerald G, Granger CB, et al. Factors related to heart rupture in acute coronary syndromes in the global registry of acute coronary events. Eur Heart J. 2010;31(12):1449-1456.
Becker AE, van Mantgem JP. Cardiac tamponade. A study of 50 hearts. Eur J Cardiol. 1975;3(4):349-58.
Smyllie JH, Sutherland GR, Geuskens R, K Dawkins , N Conway , JR Roelandt. Doppler color flow mapping in the diagnosis of ventricular septal rupture and acute mitral regurgitation after myocardial infarction. J Am Coll Cardiol. 1990;15:1449-55.
Arnaoutakis GJ, Zhao Y, George TJ, Sciortino CM, McCarthy PM, Conte JV. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2012;94(2):436-43; discussion 443-444.
Papalexopoulou N, Young CP, Attia RQ. What is the best timing of surgery in patients with post-infarct ventricular septal rupture? Interact Cardiovasc Thorac Surg. 2013;16(2):193-6.
Menon V, Webb JG, Hillis LD, Sleeper LA, Abboud R, Dzavik V, et al. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize Occluded Coronaries in cardiogenic shock? J Am Coll Cardiol. 2000;36(3 Suppl A):1110-6.
Dalrymple-Hay MJ, Monro JL, Livesey SA, Lamb RK. Postinfarction ventricular septal rupture: the Wessex experience. Semin Thorac Cardiovasc Surg. 1998;10:111-6.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 CES Medicina
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Derechos de reproducción (copyright)
Cada manuscrito se acompañará de una declaración en la que se especifique que los materiales son inéditos, que no han sido publicados anteriormente en formato impreso o electrónico y que no se presentarán a ningún otro medio antes de conocer la decisión de la revista. En todo caso, cualquier publicación anterior, sea en forma impresa o electrónica, deberá darse a conocer a la redacción por escrito.
Plagios, duplicaciones totales o parciales, traduccones del original a otro idioma son de responsabilidad exclusiva de los autores el envío.
Los autores adjuntarán una declaración firmada indicando que, si el manuscrito se acepta para su publicación, los derechos de reproducción son propiedad exclusiva de la Revista CES Medicina.
Se solicita a los autores que proporcionen la información completa acerca de cualquier beca o subvención recibida de una entidad comercial u otro grupo con intereses privados, u otro organismo, para costear parcial o totalmente el trabajo en que se basa el artículo.
Los autores tienen la responsabilidad de obtener los permisos necesarios para reproducir cualquier material protegido por derechos de reproducción. El manuscrito se acompañará de la carta original que otorgue ese permiso y en ella debe especificarse con exactitud el número del cuadro o figura o el texto exacto que se citará y cómo se usará, así como la referencia bibliográfica completa.
Article metrics | |
---|---|
Abstract views | |
Galley vies | |
PDF Views | |
HTML views | |
Other views |