A New Murmur After Successful Reperfusion: Post-infarction Ventricular Septal Rupture Diagnosed by Bedside Examination

Post-myocardial infarction ventricular septal defect (PIVSD) is an uncommon but devastating mechanical complication of acute myocardial infarction.We describe the case of a 63-year-old man with cardiovascular risk factors and prior coronary artery disease (CAD) who presented 7 hours after symptom onset with an anterior ST-segment elevation myocardial infarction (STEMI) and underwent percutaneous coronary intervention (PCI).Despite a stable clinical course, a new systolic murmur appeared 72 hours later, prompting repeat transthoracic echocardiography, which demonstrated a ventricular septal defect with associated left ventricular aneurysmal change.Following multidisciplinary Heart Team discussion, the timing of surgical repair was individualized: given the patient's sustained hemodynamic stability and the defect's anatomical characteristics, a deferred approach was considered acceptable in this specific setting, under close clinical and echocardiographic surveillance.Surgical management subsequently consisted of apical amputation.This case illustrates that delayed mechanical complications may occur despite favorable early revascularization, and emphasizes the value of vigilant clinical monitoring, timely imaging reassessment, and patient-tailored decision-making regarding the timing of repair, which should integrate hemodynamic status, defect anatomy, tissue characteristics, and overall clinical condition.