A 58-year-old man develops sudden loss of consciousness 4 hours after an acute anterior STEMI. ECG shows ventricular fibrillation. Which complication of myocardial infarction is most likely responsible?

• A Cardiac free wall rupture
• B Ventricular septal rupture
• C Papillary muscle rupture
• D Reperfusion arrhythmia ✓

Explanation

Ventricular fibrillation within 24 hours of MI is most commonly a reperfusion arrhythmia, occurring after successful thrombolysis or spontaneous recanalization. Free wall rupture and VSD typically occur 3 to 5 days post-infarction when necrosis is maximal. Papillary muscle rupture also occurs later (2 to 7 days) and presents with acute pulmonary edema and a new holosystolic murmur, not VF.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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