A Case Report: Point-of-care Ultrasound in the Diagnosis of Post-Myocardial Infarction Ventricular Septal Rupture

Abstract

Introduction: Ventricular septal rupture (VSR) is a rare complication of ST-elevation myocardial infarction (STEMI), typically discovered post-revascularization. Case report: We present the first case of VSR detected on point-of-care ultrasound (POCUS) in the emergency department immediately prior to emergent angiography, with management positively affected by this discovery. The VSR was quickly confirmed via right heart catheterization. Subsequently, hemodynamic stability was achieved using an intra-aortic balloon pump. A delayed surgical VSR repair, with concomitant coronary artery bypass grafting, was implemented for definitive management. Conclusion: This case highlights the utility of POCUS in a STEMI patient with a suspected mechanical complication.

A new dimension to the STEMI-related mortality risk seen in the COVID-19 pandemic era

“…Clinical and echocardiographic recognition of VSR coinciding with electrocardiographic recognition of STEMI ( Table 1 ). In this category there were 42 cases [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ] (28 males) of mean age 67. The period of pre-hospital delay ranged from 6 h to 3 months.…”

“…The period of pre-hospital delay ranged from 6 h to 3 months. Twelve cases had a pre-hospital delay of 7 days or more [ [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ].…”

Ventricular Septal Rupture and Artificial Intelligence (AI)-Assisted Healthcare

“…In the ED, POCUS is a quick, non-invasive imaging technique that is simple to use and very effective in diagnosing VSR. It is an efficient method for determining the cause of different shock states and other mechanical problems (e.g., RV wall rupture and aortic dissection) in urgent care [ 19 ]. Profuse bilateral B-lines with smooth pleural morphology seen during POCUS are indicative of pulmonary edema [ 20 ].…”

Murmur in a 62-Year-Old Man After Inferior Wall Myocardial Infarction

“…As imaging tools have become increasingly relied on by frontline clinicians, including doctors in training, correlating real-time bedside ultrasound findings and characteristic physical examination signs often leads to a better understanding of the underlying pathophysiologic features. 7 In a future where a point-of-care ultrasound may become a standard practice as an adjunct to listening with a stethoscope, 8 point-of-care clinical information will continue to remain vital in supporting frontline physicians' efforts toward accurate diagnosis and lifesaving decision-making.…”