Highlights the critical need for high clinical vigilance and systematic diagnostic work-up to detect ventricular septal rupture complicating silent myocardial infarction in elderly patients with atypical presentations.
May heighten suspicion for VSR after silent MI in elderly patients; leaves open validation of systematic diagnostic approaches.
Silent myocardial infarction followed by ventricular septal rupture (VSR) is a rare phenomenon. In the absence of a timely diagnosis and surgical correction, the short term mortality of such patients is greater than 90%. We present one such unique case of a patient with an asymptomatic myocardial infarction complicated by VSR, type 2 diabetes mellitus and chronic bronchitis. Unfortunately, this possibly life-threatening condition had been misdiagnosed for more than one month after initial medical contact. Lack of typical symptoms of chest pain and chronic bronchitis is primarily responsible for this long-time misdiagnosis. We want to emphasize the importance of systematic diagnostic work-up, high vigilance for possibility of VSR complicating myocardial infarction in aged patients with diabetes and chronic bronchitis, which may mislead doctors' judgments and put patients at high risk.
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Rayhan et al. (2015) studied this question.
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