Cardiac Tamponade as a Cause of Sudden Death: Autopsy-based Case Studies and Clinicopathological Correlation

Abstract Background Cardiac tamponade is a critical, life-threatening condition characterized by the accumulation of fluid or blood in the pericardial sac, leading to impaired cardiac function and often sudden death. While it can arise from various etiologies, rupture following acute myocardial infarction (AMI) remains a significant cause. This study aims to contribute to forensic cardiopathology by presenting two diagnostically rare and instructive cases of cardiac tamponade due to myocardial rupture, including a rare right ventricular rupture. Case Presentation: This study presents two cases of death following cardiac tamponade due to ruptured myocardial infarction, detailing clinical presentation, autopsy findings, and histopathological examinations. These cases are particularly valuable for highlighting the challenging postmortem diagnosis of myocardial rupture as a cause of sudden cardiac death, especially when initial clinical signs are subtle or progression is rapid. Case 1 involved a male patient in his 60s, who presented unresponsive with acute chest pain and respiratory distress; autopsy revealed approximately 360 mL of clotted blood in the pericardial sac and a 5 mm rupture in the posterior wall of the right ventricle. Case 2 describes an elderly male, also in his 60s, who experienced severe chest pain and dyspnea; postmortem examination identified approximately 330 mL of blood clots within the pericardial cavity and a sizeable 2.5 cm × 1 cm tear in the anterior wall of the left ventricle. Conclusion These cases underscore the importance of rapid diagnosis and urgent intervention in clinical settings and heightened awareness among clinicians and forensic experts regarding this rare but ultimately fatal complication. The findings highlight the critical role of meticulous postmortem examination in elucidating the cause of sudden cardiac death attributed to myocardial rupture.