Concomitant Posterior Ventricular Septal Rupture and Left Ventricular Pseudoaneurysm Triggered by Isolated Posterior Descending Artery Occlusion: A Case of Surgical Salvage

Case reportby systemic fluid overload.Physical examination revealed cold, clammy extremities, marked jugular venous distension, and bilateral basal pulmonary crepitations.Vital signs demonstrated severe hypotension (systolic blood pressure fluctuating down to 62 mm Hg) and a tachycardic pulse rate of 102 beats per minute.An admission 12-lead electrocardiogram (ECG) demonstrated normal sinus rhythm with an extreme right axis deviation (RAD).Pathological Q waves were visible in leads II, III, aVF, I, and aVL.Persistent ST-segment elevations were noted in the inferior leads (II, III, and aVF), alongside deep T-wave inversions in leads I and aVL, confirming an evolved inferior wall myocardial infarction (IWMI).Concurrently, reciprocal ST-segment depressions were evident across precordial leads V2 and V3, indicating extensive posterior transmural wall involvement consistent with a dominant terminal territory distribution occlusion.Laboratory biomarkers confirmed advanced myocardial necrosis and secondary end-organ hypoperfusion: high-sensitivity troponin I was 4008.1 ng/L, and N-terminal pro-brain natriuretic peptide (NT-proBNP) was 16,749 pg/mL.Serum chemistry revealed acute kidney injury with a serum case descrIptIon A 64-year-old male with a 3-year history of medically managed systemic hypertension presented with a 4-day history of progressive, unremitting retrosternal chest pain, accompanied by pyrexia, chills, and recurrent emesis.On initial clinical evaluation, the patient was in profound, refractory cardiogenic shock complicated