Management of right heart failure in acute myocardial infarction (AMI) includes emergent reperfusion of the infarct-related artery, fluid resuscitation, vasopressor and inotropic support, and trans-venous pacing in the presence of high-grade atrio-ventricular conduction block. Historically, mechanical support for right ventricular failure after an AMI has been limited to intra-aortic balloon pump (IABP) counterpulsation or surgically placed ventricular assist devices. Recently, a percutaneous right ventricular assist device (pRVAD, TandemHeart; CardiacAssist Inc., Pittsburgh, Pennsylvania) has offered an intermediate alternative for patients with refractory right heart failure in the setting of AMI. We describe a novel approach to pRVAD implantation via the right internal jugular vein in the setting of cardiogenic shock secondary to an acute inferior myocardial infarction.