The development of cath-lab network providing interventions in acute coronary syndromes led not only to significant reduction of major adverse cardiac events, but also reduced incidence of myocardial infarction (MI) mechanical complications in acute phase. In the pre-interventional era one of the most common complication of ST elevation MI was left ventricular free wall rupture (LVFWR). Currently it became a rare complication, but despite the advances in cardiosurgical treatment is still associated with high mortality rate. We report the case of a 75-year-old woman with inferior wall MI and LVFWR of atypical presentation.