Background: Post-ischemic ventricular rupture is a rare late complication of acute myocardial infarction and despite improvements in diagnosis, in medical and surgical treatment; it is still associated with a high mortality rate. Case Presentation: We present a case of septal rupture in a patient with an asymptomatic inferior STEMI, whose clinical examination was significant only for a systolic heart murmur. Diagnosis was made in the Emergency Department, about 6 hours from triage and about 1 hour from first medical evaluation. A multidisciplinary team managed the patient, who underwent an emercency PCI and reperfusion and then a late surgery at day 8 from diagnosis. Conclusion: Although it is a rare event, septal rupture is a life-threatening event and should be suspected in patients with myocardial infarction when a rapid hemodynamic deterioration, heart murmur, or right ventricle overload is observed. Bedside echocardiography allows early diagnosis and the management of the patient.

Keywords: Acute myocardial infarction, post-ischemic ventricular rupture, heart murmur, cardiothoracic surgery, emergency PCI, echocardiography, case report