[Rupture of the interventricular septum after acute myocardial infarction in the absence of typical symptoms and electrocardiographic changes. A case report].

A 79 year old man with sudden dyspnea, syncope and third degree heart block underwent a pacemaker (PM) implantation. He persisted with these symptoms and on the third day after the procedure it was detected a precordial holosystolic murmur. A ventricular septal rupture consequence of PM implantation was suspected. The coronary-ventriculography revealed a 99% stenosis in right coronary artery, inferior myocardial infarction and an interventricular communication. Previously, there were no other clinical manifestations nor electrocardiographic alterations suggestive of myocardial ischemia or infarction in this patient. We discuss about the rare association of an unrecognized acute myocardial infarction complicated by ventricular septal rupture.