A 70-year-old woman with a history of angina and hypertension presented with a large anterior infarct complicated by rupture and tamponade. Angiography showed triple-vessel disease and a large anteroapical aneurysm. Operative findings included extensive dissection of the septum and rupture of the right ventricular free wall. The patient survived the operation, which included replacement of the left ventricular free wall, extensive patching of the septum, and plication of the infarcted right ventricle.