Post-myocardial infarction ventricular septal defect (post-MI VSD) is a rare complication of ST-elevation myocardial infarction (STEMI) with an incidence of <1% in early revascularization era. Here we present the case of a 66-year-old woman with post-MI VSD owing to delay in her presentation in the current pandemic. Patient presented with worsening back pain and chest pain with confusion, and an EKG positive for inferior wall STEMI. She underwent emergent percutaneous intervention with placement of drug-eluting stent in her right coronary artery. She developed worsening heart failure and new-onset heart murmur and was found to have a VSD on a transthoracic echo. Because of her poor prognosis, family decided to pursue comfort care and patient unfortunately passed. Delay in seeking health care during the pandemic, as seen in our patient, is multifactorial including fear of contracting infection, decreased emergency medical services members, and concerns for overburdening healthcare systems. Lack of standardized in-hospital approach to emergencies while ensuring adequate protection from infection to healthcare workers, especially during the initial phase of the pandemic, led to increased door-to-balloon times in addition to the increased time to first medical contact. The importance of media outreach ensuring availability of health care in emergencies, changing emergency response algorithms to ensure safety of patients and healthcare providers, and including thrombolytic therapy where there is a delay due to stringent screening or delayed COVID-19 testing can be used to prevent worsening complications following STEMI.

INTRODUCTION: Malignancy is a chronic condition that induces significant emotional, physical, and psychological stress. Multiple cancer agents have been associated with Takotsubo Cardiomyopathy (TCM). Here we present a case of TCM associated with the Trametinib and Dabrafenib chemotherapy regimen presenting as Acute Coronary Syndrome.

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Post myocardial infarction ventricular septal defect (VSD) is a rare complication of ST-elevation MI with only 0.2% incidence, due to guidelines of early reperfusion therapy. Here we present the case of a 66-year-old woman with acute on chronic back pain who was found to have STEMI and a complete Right Coronary Artery (RCA) occlusion, complicated by a VSD the day after emergent stent placement. CASE PRESENTATION: A 66 year-old woman with a history of smoking, COPD, and chronic back pain, presented with chest pain and confusion. She had visited an outside facility twice with worsening back pain. EKG wasn't done both times, considering her symptoms as exacerbation of her chronic problems. On her third presentation, EKG demonstrated an inferior wall STEMI and emergent cardiac catheterization demonstrated a completely occluded RCA. She had an LVEF of 30-35% on ventriculography, no VSD was noted. She had worsening respiratory and hemodynamic status, necessitating transfer to the ICU for intubation and pressor support. The following morning a transthoracic echocardiogram (TTE) revealed a large VSD, and her lactic acidosis continued to worsen. Patient was deemed too unstable for surgical intervention and we planned to transfer her to a facility offering Extra Corporeal Membrane Oxygenation therapy (ECMO). However, the patient's family didn't want to pursue aggressive treatment options and she was transitioned to comfort care measures. She passed away the same day.