Angiotensin converting enzyme inhibitor and coenzyme Q10 as adjunctive treatment for patients with ventricular septal rupture following late onset myocardial infarction: a case report

Abstract

Ventricular Septal Rupture (VSR) is a rare complication of
acute myocardial infarction and has a high mortality rate.
Surgery is the definitive treatment. However, in hospitals
with limited facilities, treating acute myocardial infarction
patients with ventricular septal rupture, is challenging. A
74-year-old woman came to the emergency room of Dr.
Koesma General Hospital, Tuban, East Java in December,
2019 with late-onset Acute Myocardial Infarction. On the
following day, a new holosystolic murmur was heard in
the left lower sternal border with palpable thrill.
Transthoracic echocardiography showed VSR with severe
pulmonary hypertension. This was followed by a drop in
the blood pressure to 80/50 mmHg. The blood pressure
was dependent on vasopressors until lisinopril and
coenzyme Q10 were introduced. After 3 months, the
haemodynamics of the patient were stable. This proved
that the use of angiotensin-converting enzyme and
coenzyme Q10 promotes more energy production,
enables tissue healing and leads to balanced remodelling
to increase the survival rate in cases of non-surgical
treatment.
Keywords: Lisinopril, Ventricular Septal Rupture, Heart
Murmurs, Vasoconstrictor, Hemodynamics, Angiotensin’s,
Infarction, Coenzymes