Posterior left ventricular free wall rupture is rare, difficult to diagnose, and potentially fatal secondary to tamponade. The optimal surgical technique is controversial, and the outcome depends on the severity of the rupture. A 51-year-old man with acute myocardial infarction complicated by posterior wall rupture presented in extremis with retrosternal pain. Transthoracic echocardiography confirmed the finding with pericardial effusion. The patient underwent successful emergency surgical repair. Although successful salvage following surgical repair remains relatively rare, timely diagnosis with effective communication, use of imaging modalities, and an optimal surgical technique can lead to earlier intervention, thus increasing the possibility of survival.