Post-myocardial Infarction Associated Ventricular Septal Defect in an Older Female.

Background: Ventricular septal defect (VSD) is a serious but uncommon complication that can develop 2 days to 2 weeks after a myocardial infarction (MI), particularly if percutaneous coronary intervention (PCI) is delayed. Case presentation: A 91-year-old woman with a history of coronary artery disease had undergone PCI in left anterior descending (LAD) and left circumflex artery (LCX) for a non-ST-elevation myocardial infarction (NSTEMI) 4 weeks prior at another facility, which was complicated by distal wire perforation leading to hemopericardium and the need for pericardiocentesis. She presented with chest pain, and her tests showed ST-segment elevation in leads I, aVL, V2-5, and ST-depression on III, avF, and high troponin levels which were concerning for stent thrombosis. Due to her age and multiple comorbidities, she was managed medically and her code status was changed to do-not-resuscitate/do-not-intubate (DNR/DNI) after family discussion. Echocardiogram revealed a severely reduced ejection fraction and a new mid-inferoseptal VSD detected on readmission. The patient died 4 days later, highlighting the critical importance of timely PCI to prevent severe complications like VSD. Conclusions: VSD lesions although uncommon with the advent of PCI should always be considered in cases with septal lead STEMI and new onset murmur. VSD remains a late complication of STEMI in patients who are managed medically and not offered PCI.