B50-12 Delayed Presentation of Ventricular Septal Rupture After Myocardial Infarction

Background Ventricular septal rupture (VSR) after myocardial infarction is rare but highly lethal, with mortality up to 90% when managed conservatively. Delayed presentation remains a major risk factor. Case A 60-year-old woman with bipolar disorder,panic attacks and an unreliable history, presented after over a week of chest discomfort, dyspnea, nausea, and anxiety. She attributed symptoms to panic attacks and was non-compliant with medications. On admission, she was hypotensive and tachycardic, with inferior ST-segment elevation and Q waves. Catheterization revealed complete right coronary artery occlusion with heavy thrombus. Balloon angioplasty was performed; stenting was deferred due to late presentation. A Delayed Echocardiography revealed preserved left ventricular function, right ventricular dilation with reduced function, and a large muscular VSR. Decision-Making Despite vasopressors and anticoagulation, she developed worsening cardiogenic shock. Early echocardiography should have been obtained, as the delay limited options. VA ECMO was initiated as a bridge to repair. Psychiatric comorbidities and unreliable history contributed to late recognition. Despite maximal support, she developed multi-organ failure and died. Conclusion Delayed presentation after myocardial infarction can cause catastrophic complications such as VSR. Early recognition, timely echocardiography, multidisciplinary care, and prompt surgical repair are essential for survival.