Post Myocardial Infarction Ventricular Septal Defect

ST segment elevation myocardial infarction (STEMI) is a well described medical emergency with significant strides in medical management drastically improving survival, however its complications are less frequently described.It can be a difficult task to determine the cause of an acute decompensation after successful revascularization of a STEMI.The differential includes a myriad of acute medical and surgical emergencies, including re-occlusion, stent thrombosis, and mechanical dysfunction of the free wall, septum or valves.Among these is the rare and often fatal acquired ventricular septal defect (VSD).A high index of suspicion of this complication is necessary for early recognition to improve survival.We present a case of an 83-year-old male who after 14 days of a hospital admission for STEMI with successful revascularization had an acute decompensation from hypoxemia refractory to oxygen supplementation requiring emergent intubation and hemodynamic instability requiring multiple pressor support.He was noted to have a new holosystolic murmur and a bedside transthoracic echocardiogram showed a large left-toright shunt, evident for a VSD.He underwent successful repair of the VSD and was discharged on postoperative day 42.