Ventricular septal rupture is a rare but important complication occurring in around 1%–3% of cases of acute myocardial infarction and carries a high mortality.1 We report a patient in whom a ventricular septal rupture was better tolerated due to a serpiginous course of the rupture, combined with an unusual pseudoaneurysm of the septum.

A 69-year-old male subject was admitted to our emergency department with a 2-week history of exertional breathlessness, which was preceded by an acute episode of precordial discomfort for which the patient did not seek medical attention. On clinical examination, the resting heart rate was regular at 100 beats per minute. The supine blood pressure was 95/75 mm Hg. There were signs of moderate biventricular failure and a loud pan-systolic murmur loudest at …