Ventricular Septal rupture in a patient with NSTEMI

Abstract

A 67 years old male patient presented with chief complaint of typical chest pain associated with shortness of breath since 2 days. There is a history of atypical chest pain 2 years back, at that time patient clinical examination, ECG, exercise electrocardiography (TMT) and echocardiographic examination are normal. There is no history of diabetes mellitus and Hypertension although patient is a chronic tobacco chewer. On clinical examination heart rate is around 130 beats/min and blood pressure is 90/60 mm Hg, heart sounds are normal and a harsh pansystolic mummur with thrill (grade 4/6) present on left lower sternal border. ECG shows ST segment depression in lead II,III,aVF,V4-V6, troponin T is positive, chest xray is normal. Patient diagnosed as case of ACS NSTEMI and treatment started on the line of ACS. Echocardiography shows regional wall motion abnormality in inferoseptal and inferior segment with mild LV systolic dysfunction(LVEF-48%) with moderate MR and a basal ventricular septal defect which shows left to right shunt on color doppler imaging in apical 2 chamber view suggestive of ventricular Septal rupture. Blood investigation shows mildly raised TLC count and deranged lipid profile. Renal and liver function test were normal.