A case of myocardial infarction with severe shock, marked systemic venous congestion and transient A-V block was observed in our Coronary Care Unit four years ago; signs of pulmonary venous congestion were absent. The patient, still alive, remains seriously incapacitated, with persistent signs of right ventricular failure. Recently, coronary angiography has shown total proximal obstruction of a "dominant" right coronary artery. The left coronary artery was free from significant obstructions. Right and left ventriculography have shown severe diffuse impairment of right ventricular contractility and akinesis of the left ventricular posterobasal segment. Echocardiography has demonstrated marked paradoxical movement of the interventricular septum. The scanty literature on this rare syndrome is reviewed; diagnostic criteria, therapeutic approaches and prognosis are briefly discussed.