Post-infarction ventricular septal rupture complicating delayed presentation of anterior ST-segment elevation myocardial

Ventricular septal rupture (VSR) is a rare but severe mechanical complication of acute myocardial infarction (AMI). We report a 54-year-old man with diabetes mellitus and hypertension who presented with anterior ST-segment elevation myocardial infarction (STEMI). The patient sought medical attention three days after symptom onset. On admission, he was in Killip class II and had a new holosystolic murmur with widespread precordial radiation. Transthoracic echocardiography confirmed an apical VSR with a left-to-right shunt and preserved left ventricular systolic function. Pulmonary artery systolic pressure was estimated at 50 mmHg. Coronary angiography showed proximal left anterior descending artery occlusion. Intravenous fibrinolysis was administered due to the absence of immediate access to primary percutaneous coronary intervention. The patient subsequently developed progressive hemodynamic deterioration leading to cardiogenic shock and death. This case highlights the impact of delayed presentation and the importance of early recognition of mechanical complications.