Echoes of a silent rupture: acute right ventricular failure due to post-ischemic ventricular septal defect in the emergency department – a case report

OBJECTIVES: Post-infarction ventricular septal defect is a rare but severe mechanical complication of acute myocardial infarction that can lead to cardiogenic shock and carries a high mortality rate. Early recognition and multidisciplinary management are essential for improving survival. CASE PRESENTATION: A 58-year-old previously healthy woman presented to the Emergency Department with syncope and cardiogenic shock due to an anterior myocardial infarction. Echocardiography revealed an apical ventricular septal defect with severe biventricular dysfunction and right ventricular failure, confirmed by computed tomography. Urgent coronary angiography demonstrated total occlusion of the left anterior descending artery, treated with stent implantation. Despite maximal medical therapy, she required emergency surgical repair with patch closure and concomitant coronary bypass grafting. CONCLUSIONS: This case highlights the challenges of post-infarction VSD presenting with predominant right sided heart failure, requiring rapid and multidisciplinary management, including prompt surgical intervention, and advanced mechanical circulatory support.