A case of ruptured septic myocardial infarct with death from cardiac tamponade in an intravenous drug addict with left-sided infective endocarditis and septic coronary artery embolism is described. To the best of our knowledge, there is no previous report of such a case in the literature. Although uncommon, infective endocarditis with coronary embolisation is a well-documented cause of myocardial infarction, although not normally associated with ventricular free wall rupture, and should be considered in intravenous drug addicts who present with cardiac symptoms and signs of sepsis.