Ventricular septal rupture (VSR) after acute myocardial infarction is increasingly rare in the percutaneous coronary intervention era but mortality remains high. The event occurs 2-8 days after an infarction and often precipitates cardiogenic shock. [1] The differential diagnosis of postinfarction cardiogenic shock should exclude free ventricular wall rupture and rupture of the papillary muscles Prompt diagnosis is key. Alternatively, delaying surgery in stable patients may provide better results. Prolonged medical management is usually futile, percutaneous VSR closure may be used as a temporizing measure to reduce shunt, or for patients in the sub-acute to chronic period.