A patient develops a new holosystolic murmur 4 days after an inferior STEMI. Bedside echocardiography shows a left-to-right shunt at the ventricular level with moderate-to-severe haemodynamic compromise. What is the definitive treatment?
- A Emergency surgical repair of ventricular septal defect ✓
- B Intravenous nitroprusside infusion
- C Percutaneous closure with Amplatzer device
- D Intra-aortic balloon pump as definitive treatment
Correct answer: A. Emergency surgical repair of ventricular septal defect
Explanation
Post-infarction ventricular septal defect (VSD) is a mechanical complication of STEMI with very high mortality without surgical repair. Emergency surgery is the definitive treatment, with IABP and vasopressors used as a bridge. Percutaneous closure has been attempted but outcomes are inferior due to friable tissue in the acute phase. Nitroprusside can transiently reduce afterload but is not definitive. IABP improves haemodynamics but does not close the defect.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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