[A man in his sixties with dyspnoea and systolic murmur after myocardial infarction]. / En mann i 60-årene med dyspné og systolisk bilyd etter hjerteinfarkt.
Tidsskr Nor Laegeforen
; 144(2)2024 02 13.
Article
in Nor
| MEDLINE
| ID: mdl-38349103
ABSTRACT
Background:
Ventricular septal rupture (VSR) following acute myocardial infarction is rare in the modern revascularisation era. Nevertheless, clinical awareness is paramount, as presentation may vary. Case presentation A middle-aged male with no history of cardiovascular disease developed progressive heart failure symptoms while travelling abroad. Initial workup revealed a prominent systolic murmur, but findings were inconsistent with acute coronary syndrome. Transthoracic echocardiogram showed a small hypokinetic area in the basal septum, preserved left ventricular function and no significant valvulopathy. Despite the absence of chest pain, an invasive angiography revealed occlusion of a septal branch emerging from the left anterior descending artery, otherwise patent coronary arteries. Despite administration of diuretics, the patient remained symptomatic and presented two months later to his primary care provider with a persisting systolic murmur. He was subsequently referred to the outpatient cardiology clinic where echocardiography revealed a large VSR involving the basal anteroseptum of the left ventricle with a significant left-to-right shunt. After accurate radiological and haemodynamic assessment of the defect, he successfully underwent elective surgical repair.Interpretation:
Although traditionally associated with large transmural myocardial infarctions, VSR may arise also from minor, subclinical events. A new-onset murmur is a valuable hint for the alert clinician.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Ventricular Septal Rupture
/
Systolic Murmurs
/
Myocardial Infarction
Type of study:
Diagnostic_studies
/
Etiology_studies
Limits:
Humans
/
Male
/
Middle aged
Language:
Nor
Journal:
Tidsskr Nor Laegeforen
/
Tidsskr. nor. laegeforen
/
Tidsskrift for den norske laegeforening
Year:
2024
Document type:
Article
Country of publication: