Best Cases: Ischemic Heart Disease-Ruptured interventricular septal aneurysm and septal dissection following inferior wall STEMI

Ruptured interventricular septal aneurysm and septal dissection following inferior wall STEMI - A rare complication

Video Transcription

Video Summary

A 55-year-old woman with diabetes, hypertension, and dyslipidemia developed orthopnea and pulmonary edema 20 days after a conservatively treated inferior STEMI. Exam revealed JVD, basal crackles, and a pansystolic murmur. Echo showed a large basal ventricular septal rupture with left-to-right shunt. Cardiac MRI confirmed septal thinning, dissection, aneurysm formation, and a Qp/Qs of 2.8, with mild MR and pericardial effusion. Coronary angiography showed severe mid-RCA stenosis. Ventricular septal rupture is a rare, deadly post-MI complication; CMR helps define anatomy and guide surgery versus catheter intervention.

Keywords

ventricular septal rupture

inferior STEMI

cardiac MRI

left-to-right shunt

coronary angiography