This meme is laid out in a bit of a different format, running up and down instead of right to left. It is a two panel sketched cartoon strip, with the design remaining the same and different text substituted to follow the meme characteristics.
The first panel shows a couple discussing something, Both are clam, and the boyfriend is standing there calmly while the girlfriend says something. The second panel shows an abrupt change. The boyfriend punches the girlfriend, blood sprays out of her face, and he says something to punctuate his physical statement.
The cartoon is a real one, and this particular one first showed up on a Portuguese humor website called Dentra da Caviera. The original panels on the site acted out the male of the couple accusing the woman of being a pedophile.
The image is quite artistic, with the sketch of the couple having a water color effect. The blood spatter is quite dramatic, and draws the focus to the last statement of the panel, whatever it is.
There are many variations of this meme. Some of them have a first line and a punch line, but often there is only one line or even one word for punctuation and effect.