The co-occurrence of rare and Lethal complications of myocardial infarction (MI) in metabolic syndrome (MetS). A 70-year-old man with hypertension and diabetes presented to our emergency department with a 3-day history of sudden onset of severe chest pain that is associated with diaphoresis, shortness of breath, feeling of impending doom, nausea, and unrecordable blood sugar on admission.

Meticulous physical examinations revealed pansystolic murmur loudest at left sternal edge, loud pulmonary component of second heart sound (P2), bi-basal coarse crepitation. While focus investigations revealed unrecordable random blood sugar (RBS), electrocardiography (ECG) significant ST segment elevation in leads II, III and aVF, elevated cardiac markers and NT pro BNP, echocardiography established ventricular septal defect, and derange urea, electrolyte and creatinine. A definitive diagnosis of inferior wall ST-elevation myocardial infarction (STEMI) complicated by acute heart failure (HF), ventricular septal defect (VSD), cardiogenic shock (CS), and cardiorenal syndrome (CRS) with co-occurring hyperosmolar hyperglycemic state (HHS) in MetS was established. He was stabilized with appropriated medical therapy and referred to heart surgery capable hospital.

This case underscores the potential for severe, life-threatening complications of myocardial infarction in metabolic syndrome particularly in resource constrained settings. Early recognition and timely referral to cardiac surgery capable centre are crucial for improving outcomes in such cases, especially in resource-limited settings.

Keywords: Post infarction ventricular septal defect; Heart failure; Cardiogenic shock; Cardiorenal syndrome; Metabolic syndrome