Case Report:
A 57-year-old man suffered sudden chest pains, mainly in the middle and
lower sternum, accompanied by sweating, while he rested at home 4 months
ago. He chose to delay medical care because of the COVID-19 epidemic.
Three months later, he developed chest tightness, shortness of breath
and other discomfort. The symptoms of depression and shortness of breath
aggravated significantly after a little activity, complicating systemic
edema, especially in the extremities. Physical examination after
admission revealed heart rate of 98 beats/min, blood pressure of
131/103mnHg, no rales in both lungs, intermittent rales in the third and
fourth ribs and systolic ejection murmur on the left sternal border.
Besides, Troponin was 0.01μg/L; CK-MB was 12.8U/L; BNP was 880.6pg/ml.
Electrocardiogram indicated myocardial infarction of anterior interwall
and anterior wall (Figure 1 A). Color echocardiography revealed abnormal
movement of the anterior and interanterior walls of the left ventricle
with septal perforation (Figure2 A). Myocardial CT showed myocardial
defects at the apex of the ventricular septum, being consistent with
myocardial perforation (Figure 3). Coronary angiography revealed a
three-vessel lesion.( (Figure4 A)(174)
The patient improved slightly after the treatment of vasodilating,
diuresis and heart strengthening. For ventricular septal defect, there
was high risk of surgery according to the cardiac surgery consultation.
His family members gave up surgical treatment and interventional
plugging treatment. The patient was treated with anti heart failure
drugs after risk assessment. The patient was followed up in our hospital
every 3 months. During the period, his chest tightness, shortness of
breath and other symptoms did not worsen. Color echocardiography reveals
there was no ventricular septal defect enlargement and cardiac function
decline. The patient developed chest tightness, and increased shortness
of breath, with significant restrict of activity after 22 months.
Physical examination revealed heart rate of 98 beats/min, blood pressure
of 131/103mnHg, no rales in both lungs, intermittent rales in the third
and fourth ribs and systolic ejection murmur on the left sternal border.
Supplementary examination revealed that Troponin and CK-MB were within
normal limits. Electrocardiogram indicated old myocardial infarction
(Figure1 B). Color echocardiography showed no enlarged perforation
(Figure 2 B).
Percutaneous transcatheter closure was chosen after communication with
family members (Figure4 B). Postoperative echocardiography showed
changes after ventricular septal closure (Figure2 C). After treatment
with anti-heart failure and symptomatic support, the patient’s symptoms
of chest tightness and shortness of breath were relieved. And he was
discharged from the hospital upon recovery.