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Post-MI VSD — RACP Adult Medicine MCQ

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ModerateCardiologyPost-MI VSDRACP Adult Medicine

A 65-year-old man with an anterior STEMI treated with primary PCI 3 days ago develops a new loud pansystolic murmur, acute pulmonary oedema, and cardiogenic shock. Echo shows a ventricular septal defect (VSD) with left-to-right shunt. What is the most likely complication?

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Correct answer: D — Post-MI ventricular septal rupture

New pansystolic murmur + pulmonary oedema + cardiogenic shock 3-5 days after STEMI with echo-confirmed VSD is post-MI ventricular septal rupture. This is a mechanical complication with high mortality (50-80% without surgery). Management: urgent surgical repair (or percutaneous device closure in select cases), IABP for haemodynamic support, inotropes, and vasopressors. Medical stabilisation is a bridge to surgery — delay if possible to allow infarcted tissue to mature (but not if haemodynamically compromised).

Reference: CSANZ – 2025 – ACS Complications; ESC 2023