Ventricular septal rupture (VSR) is a rare condition that carries significant morbidity and mortality. It occurs as a complication of myocardial infarction affecting the interventricular septum. The introduction of thrombolytic therapy has reduced its incidence.
Ventricular septal rupture (VSR) commonly occurs as a result of myocardial infarction (MI). VSR is a rare condition that occurs in 0.3% of individuals who have suffered MI, and it carries high morbidity and mortality . Although the introduction of thrombolytic therapy has resulted in the reduction of VSR incidence, cases still occur  . Risk factors include advanced age, female sex, chronic renal diseases, and cardiovascular diseases  .
Typically VSR may present as worsening of a patient's condition after recent MI, following a short period of clinical stability and usually with complaints of chest pain and dyspnea . Mitral valve regurgitation (MVR) may present in a similar way as VSR and is thus one of the main differential diagnoses, notwithstanding that MVR complicates one in five cases of VSR. Upon examination, a significant percentage of patients have a loud holosystolic murmur, most prominent in the left sternal border, which may radiate to several areas in the chest. In addition, there is commonly a parasternal thrill. Murmurs produced by both VSR and MVR may radiate to the axilla, however, an MVR murmur is usually loudest at the apex and can be heard during diastole.
Further complications of VSR that may ensue are low cardiac output, which in turn leads to cardiogenic shock. In such cases, the characteristic murmur is less intense, and a thrill may be completely absent. There is a prominent second heart sound, pulmonary hypertension, and possibly tricuspid regurgitation as well.
An atypical presentation has been described with features of VSR emerging as the first manifestation of the disease, after a silent MI .
Medical history and medical imaging are major parts of the diagnostic process. Imaging modalities include: