Intramyocardial dissecting hematoma after myocardial infarction is a rare condition. Previous reports have documented that these hematomas form almost exclusively in the myocardium adjacent to the culprit coronary lesion. We report a case of coexistent intramyocardial dissecting hematoma and ventricular rupture that arose as a consequence of a distal right coronary artery occlusion. Unusually, there was a very long dissection plane, which crossed the atrioventricular groove, with the hematoma manifesting on the opposite side of the heart (left atrium) to the infarcted myocardium (inferior wall).