Myocardial rupture is often a catastrophic complication of acute myocardial infarction. Diagnosis can be challenging in the critically unwell patient. We present the case of a 70-year-old female who collapsed in the community with pulseless electrical activity, in cardiac arrest. She was transferred emergently to hospital where early resuscitation efforts were suggestive of a posterior myocardial infarct and severe blood loss. Point-of-care cardiac ultrasound demonstrated pericardial effusion but could not rule out aortic dissection. The patient underwent CT imaging with intravenous contrast which revealed left ventricular rupture secondary to the infarction. CT imaging can be a valuable diagnostic adjunct in patients with suspected post-infarction myocardial rupture.