A patient with extensive myocardial infarction, evidence of early ventricular remodelling, regional left ventricular (LV) dilation and aneurysm formation developed recurrent ventricular tachyarrhythmias and episodes of sudden death. The patient finally died 24 days post infarction despite effective anti-remodelling therapy and appropriate anti-failure and anti-arrhythmic therapies. Remarkable findings at autopsy included normal LV size and a small LV apical aneurysm despite as much as 52% LV necrosis and further right ventricular necrosis. The case underscores the need for aggressive early infarct-limiting therapy to prevent early remodelling, LV aneurysm and possibly fatal ventricular tachyarrhythmias.