From cardiogenic shock to surgical success: Addressing ventricular septal rupture in a myocardial infarction case

Myocardial infarction (MI) is a severe cardiac event that can lead to life-threatening complications, including ventricular septal rupture (VSR) and left ventricular aneurysm. Diabetic patients are particularly susceptible to adverse outcomes following MI. This case report presents the successful management of a 61-year-old diabetic man who developed VSR and cardiogenic shock following an evolved anterior wall MI. A 61-year-old man with a history of diabetes mellitus presented with chest pain and breathlessness for three days. An electrocardiogram (ECG) showed an evolved anterior wall myocardial infarction, and a 2D echocardiogram revealed a left ventricular apical aneurysm and ventricular septal rupture. The patient was in critical condition with pulmonary edema and cardiogenic shock, having suffered a cardiac arrest at an outside facility before transfer. On examination, a pansystolic murmur was noted in the left parasternal area. The patient was kept on a ventilator since his transfer and required ventilatory support for seven days. Immediate management included the placement of an intra-aortic balloon pump (IABP) for hemodynamic support, decongestive therapy, antiplatelet medications, and inotropic agents. After stabilization, the patient underwent left ventricular aneurysm Dor’s repair and VSR closure. The surgery was well tolerated, and the patient demonstrated a positive response to the treatment, leading to discharge in a stable condition. This case underscores the critical need for rapid diagnosis and aggressive management of myocardial infarction complicated by ventricular septal rupture and cardiogenic shock. The integrated approach of mechanical support, pharmacological therapy, and timely surgical intervention resulted in successful outcomes and highlights the importance of multidisciplinary care in managing complex cardiac emergencies.