A 65-year-old man presents with anterior STEMI and undergoes successful primary PCI. On day 2, he develops sudden hypotension, a new loud pan-systolic murmur at the left sternal border, and bilateral pulmonary oedema. Echocardiography shows a 1.5 cm defect in the interventricular septum with left-to-right shunt. What is the most appropriate management?
- A Emergency surgical repair with intra-aortic balloon pump support ✓
- B IV nitroprusside infusion and close monitoring
- C Urgent repeat coronary angiography and PCI of residual stenosis
- D Intravenous furosemide and elective percutaneous VSD closure in 6 weeks
Correct answer: A. Emergency surgical repair with intra-aortic balloon pump support
Explanation
Post-infarction ventricular septal defect (VSD) is a life-threatening mechanical complication of MI, typically occurring 3–5 days post-STEMI. The treatment of choice is emergency surgical repair with hemodynamic support (IABP or VA-ECMO), as medical management alone carries near-100% mortality. Percutaneous closure is emerging but reserved for patients with prohibitive surgical risk. Waiting 4–6 weeks for 'scar' maturation is no longer recommended given high mortality with delay. Repeat PCI addresses coronary disease but not the VSD itself.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.