Painless myocardial infarction with interventricular septal rupture presenting as the acute onset of congestive heart failure.

Two cases of ventricular septal rupture complicating infero-posterior myocardial infarction which are atypical in presentation, clinical course, and outcome are presented and the relevant literature is reviewed. The patients presented late after the acute onset of congestive heart failure, without a history of chest pain, were diagnosed noninvasively, survived with medical therapy for 2 and 4 months, and went on to successful surgical repair.