A case of a 67-year-old woman with cardiac tamponade caused by toothpick ingestion is presented. At clinical presentation, it mimicked postinfarction ventricular free wall rupture and the diagnosis was not made until the operation. Ingested toothpicks have often been reported as a cause of intestinal injuries, but in this rare case the toothpick migrated into the pericardium and caused laceration of the right coronary artery.