Predicting Ventricular Septal Rupture in ST-Elevation Myocardial Infarct in Low Resource Setting: a case series

Abstract

Background: The mortality rate caused by myocardial infarct (MI) escalates in the presence of ventricular septal rupture (VSR). This article aimed to analyze clinical factors that might be valuable as predictors of VSR.
 Case Illustration: We found and presented six documented post-infarction VSR out of 1,613 MI cases between January 2015 to December 2019.
 Conclusion: Based on the analysis, clinicians should be aware of these factors as they were potential to be the predictors: advanced age, first MI, anterior location of the infarct, infranodal conduction disorder, no reperfusion treatment, high systolic blood pressure on admission, and no smoking history.

Ventricular Septal Rupture (VSR) in Post-Acute Anterior Myocardial Infarction Patients : A Case Series

“…In a limited study said that CAD patients with hypertension will have more collateral than non-September 2022 | Vol 3 | Article 4 hypertension patient. In addition, there is cardiac hypertrophy and interstitial fibrosis (preconditioned heart) which is more resistant to damage due to MI so that the incidence of VSR is lower [1,13] . But there are different studies suggesting that high blood pressure during MI will increase the likelihood of VSR because this condition puts more stress on the weakening septum.…”

“…Possibly, this happened in both of our cases, because their blood pressure was high at the beginning of MI. [1,[13][14][15] Non-smokers (as in our two patients) will have a higher incidence of post-infarction VSR than smokers. This is because in smokers often cause the formation of collateral circulation.…”

“…But it is also still being debated and needs further investigation. [1,10,13,16] The mechanism of VSR is presence of coagulation necrosis of the ischemic tissue and characterized by neutrophil infiltration which can cause the septum to become thin and brittle. Neutrophils will trigger apoptosis and release of lytic enzymes.…”

“…Transcatheter closure of the septal defect can be an alternative therapy. Surgical closure should be performed on all patients, even if the patient is hemodynamically stable, because the septal defect can increase in size at any time [1,2,10,13] . Even though, the exact time for surgical therapy is still much debated until now [2,4,5,10] .…”