Post-infarction cardiac tamponade causing sudden death: an autopsy series highlighting right ventricular free-wall rupture

Abstract Background Cardiac tamponade is a rapidly fatal condition caused by the accumulation of fluid or blood within the pericardial sac, resulting in impaired cardiac filling and hemodynamic collapse. Myocardial rupture following acute myocardial infarction (MI) is a rare but catastrophic cause of sudden cardiac death and is often diagnosed only at autopsy. Case presentations Three cases of sudden death due to cardiac tamponade secondary to myocardial rupture were examined. Autopsy revealed hemopericardium associated with ventricular free-wall rupture in the setting of recent transmural MI. Although left ventricular rupture was the predominant finding, one case showed the uncommon occurrence of right ventricular free-wall rupture. Histopathological examination confirmed the timing and extent of infarction in all cases. Conclusion These cases highlight myocardial rupture as a critical and often fatal complication of acute MI. Careful postmortem examination, including detailed assessment of both ventricles and histopathological analysis, is essential for accurate diagnosis. Recognition of this complication has important implications for both forensic practice and clinical awareness.