“Spot the Wink: The Flashing Red Light in a Failing Heart” – Winking Coronary Sign

Abstract Ventricular septal rupture (VSR) is a rare but catastrophic mechanical complication of acute myocardial infarction (MI), carrying a high mortality risk. The winking coronary sign (WCS) is a rare but pathognomonic angiographic finding associated with VSR. We report a case of an 80-year-old male presenting with VSR following anterior wall MI, in whom WCS was visualized on coronary angiography. Surgical or device intervention was precluded due to high procedural risk and anatomical complexity, and the patient was managed conservatively.