CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 9, October 2012
AFRICA
e1
Case Report
Acute anterior myocardial infarction in an 85-year-old
male patient, complicated by the deadly duo: ventricular
septal rupture and pseudoaneurysm
AHMET C AYKAN, REGAYIP ZEHIR, CAN Y KARABAY, SINEM CAKAL, NERTILA POCI, KENAN SÖNMEZ
Abstract
Ventricular septal rupture and ventricular pseudoaneurysm
formation are rare complications of acute myocardial infarc-
tion. Immediate intervention is mandatory in these circum-
stances. Our case is a unique presentation of an anterior
myocardial infarction in an 85-year-old male, complicated by
ventricular septal rupture and ventricular pseudoaneurysm
formation.
Keywords:
ventricular septal rupture, pseudoaneurysm, acute
anterior myocardial infarction
Submitted 23/3/11, accepted 3/5/12
Cardiovasc J Afr
2012;
23
:
e1–e3
DOI: 10.5830/CVJA-2012-039
Case report
An 85-year-old man complaining of mild dyspnoea was admitted
to the emergency department. He had had an anterior myocardial
infarction eight days earlier and was hospitalised for four days
in the intensive care unit of a local hospital. He was discharged
with standard anti-ischaemic medication. He had presented at
the 18th hour of myocardial infarction, therefore thrombolytic
therapy was not administered.
At admission the patient was tachycardic (110 beats/min) and
mildly dyspnoeic. His blood pressure was 130/85 mmHg. On
physical examination, a 4/6 systolic murmur was apparent on the
apex, radiating to the axilla. He had crepitant pulmonary rales at
the bases. There were no neurological signs.
The 12-lead electrocardiogram showed sinus rhythm of 110
beats/min, with a right bundle branch block, low QRS voltage in
the limb leads, Q waves and a 4-mm ST-segment elevation in the
precordial leads (Fig. 1A). The serum troponin T level was 5 ng/
ml and the BNP level was 3 000 pg/ml.
Transthoracic echocardiography showed a ventricular septal
rupture (VSR) (Fig. 2C, D) causing a left-to-right shunt (Fig.
2
A, B), a small ventricular pseudoaneurysm (Fig. 2C, D) and
moderate mitral regurgitation. The left ventricular systolic
ejection fraction was 35%. Moderate pericardial effusion was
evident. Transoesophageal echocardiography was not performed
because of the urgency of the situation.
Coronary angiography showed 95% stenosis of the middle
and distal segments of the left anterior descending artery
(
Fig. 1B) and non-critical stenosis in the circumflex and right
coronary arteries (Fig. 1C). The patient was immediately sent to
Department of Cardiology, Kartal Kosuyolu Heart Research
and Educational Hospital, Istanbul, Turkey
AHMET C AYKAN MD,
REGAYIP ZEHIR, MD
CAN Y KARABAY, MD
SINEM CAKAL, MD
NERTILA POCI MD,
KENAN SÖNMEZ, MD
Fig. 1A. A 12-lead electrocardiogram showing sinus tachycardia with right bundle branch block, low QRS voltage in
the limb leads, Q waves, and 4-mm ST-segment elevation in the precordial leads.
A
