Ventricular septal defect (VSD) is a rare but lethal complication of myocardial infarction . We present a case of a 65-year-old male who presented with a history of progressive shortness of breath associated with productive cough . Physical examination was significant for crepitation in both lower lung fields and bilateral lower extremity edema . Chest X-ray revealed bilateral reticular opacities with small bilateral pleural effusions . Polymerase chain reaction (PCR) for COVID was positive . Echo showed a left ventricular ejection fraction (LVEF) of 30-35%, ischemic cardiomyopathy, and muscular ventricular septal defects with left to right shunting and severely elevated pulmonary artery systolic pressure . Overtime during the hospital course, he developed respiratory and fulminant hepatic failure . Our patient had VSD due to an undiagnosed old myocardial infarction (MI). Initially heart failure was compensated and treated with medical management . Later on, he developed respiratory complications related to COVID-19 infection as well as hepatic failure in addition to a cardiomyopathy which made him a poor surgical candidate leading to death.