eMedicine Specialties > Thoracic Surgery > Cardiac

Ventricular Septal Rupture Following Myocardial Infarction: Workup

Author: Shabir Bhimji, MD, PhD, Locum Cardiothoracic and Vascular Surgeon, Saudi Arabia and Middle East Hospitals
Contributor Information and Disclosures

Updated: Nov 7, 2008

Workup

Imaging Studies

  • On plain chest radiographs, 82% of patients with postinfarction ventricular septal rupture (VSR) demonstrate left ventricular enlargement, 78% have pulmonary edema, and 64% have a pleural effusion. These findings are nonspecific and do not exclude other causes such as a ruptured papillary muscle.
  • M-mode transthoracic and transesophageal echocardiography have recently been used to help diagnose postinfarction VSR.
    • Transthoracic echocardiography findings have been improved with the use of color-flow Doppler in visualizing the VSR.
    • In addition, echocardiography can help to assess the presence of any mitral valve pathology.

Other Tests

  • No ECG features are diagnostic of postinfarction VSR, though ECG indeed provides some useful information.
    • Persistent ST-segment elevation associated with ventricular aneurysm is common.
    • ECG may reveal atrioventricular block in a third of patients.
    • ECG can also be used to help predict the anatomic location of the septal rupture.

Diagnostic Procedures

  • Left heart catheterization with coronary angiography is recommended in all stable patients. Good judgment is required when ordering this test because the procedure is time consuming and carries some degree of morbidity in already-compromised patients.

More on Ventricular Septal Rupture Following Myocardial Infarction

Overview: Ventricular Septal Rupture Following Myocardial Infarction
Workup: Ventricular Septal Rupture Following Myocardial Infarction
Treatment: Ventricular Septal Rupture Following Myocardial Infarction
Follow-up: Ventricular Septal Rupture Following Myocardial Infarction
References

References

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Further Reading

Keywords

VSR, ventricular rupture, ventricle rupture, post-MI VSR, post MI ventricular rupture, postinfarct ventricular septal rupture, postinfarct VSR, postinfarction VSR, anteroapical septal rupture, posterior septal rupture, transmural infarction, loud systolic murmur, left-to-right shunt, left heart catheterization, intraaortic balloon pump, intra-aortic balloon pump, IABP, intraaortic balloon counterpulsation, IABCP, intra-aortic balloon counterpulsation cardiogenic shock, ventriculotomy, aneurysmectomy, patch repair, coronary revascularization, recurrent ventricular septal defect, ventriculoseptal defect, VSD, ventricular septal defect, congestive heart failure, CHF, coronary heart disease, CAD, heart failure

Contributor Information and Disclosures

Author

Shabir Bhimji, MD, PhD, Locum Cardiothoracic and Vascular Surgeon, Saudi Arabia and Middle East Hospitals
Shabir Bhimji, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Chest Physicians, American Lung Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey C Milliken, MD, Chief, Division of Cardiothoracic Surgery, University of California at Irvine Medical Center; Clinical Professor, Department of Surgery, University of California at Irvine School of Medicine
Jeffrey C Milliken, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, American College of Cardiology, American College of Chest Physicians, American College of Surgeons, American Heart Association, American Society for Artificial Internal Organs, California Medical Association, International Society for Heart and Lung Transplantation, Phi Beta Kappa, Society of Thoracic Surgeons, Southwest Oncology Group, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shreekanth V Karwande, MBBS, Chair, Professor, Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine and Medical Center
Shreekanth V Karwande, MBBS is a member of the following medical societies: American Association for Thoracic Surgery, American College of Chest Physicians, American College of Surgeons, American Heart Association, Society of Critical Care Medicine, Society of Thoracic Surgeons, and Western Thoracic Surgical Association
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Mary C Mancini, MD, PhD is a member of the following medical societies: American Heart Association, American Medical Association, American Thoracic Society, Association for Academic Surgery, Association for Surgical Education, International College of Surgeons, International Society for Heart and Lung Transplantation, New York Academy of Sciences, Phi Beta Kappa, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

 
 
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