Medical complications often worsen the prognosis after myocardial infarction. We report the case of a 48-year-old cigarette smoker with a 10-year history of hypertension, admitted in the emergency department with respiratory distress and global heart failure. Electrocardiography showed QS waves in anterior and lateral leads. Transthoracic echocardiography showed abnormal left ventricular contractility and a huge apical thrombus coating left ventricular lateral wall, with right ventricular dilatation. A computed tomographic pulmonary angiography revealed a pulmonary distal embolism. One week after admission, the patient presented a ventricular fibrillation stopped immediately after electrical shock. Vasopressor drugs were then introduced due to severe hypotension, and were successfully withdrawn two weeks later. On day 25, the patient suddenly presented extreme bradycardia followed by ventricular fibrillation then a cardiac arrest non responsive to cardiopulmonary resuscitation. Myocardial infarction complicated with pulmonary embolism, ventricular arrythmia and cardiogenic shock at the same time is very rare . Prognosis of such cases is very poor.