Sudden Unexplained Death due to Posterior Free Wall Cardiac Rupture Secondary to Silent Myocardial Infarction in a Hypertensive Patient: An Autopsy Case Report

Background: Cardiac rupture is a rare but highly fatal complication of acute myocardial infarction, carrying a reported mortality rate of 75-89%. While advancements in reperfusion therapy have reduced its incidence to approximately 1-3% of myocardial infarction cases, it remains a critical, life-threatening event. Case Presentation: We report the case of a 55-year-old male with a history of hypertension and chronic alcohol use who was brought to the emergency department following a sudden, unexplained death. There was no history of trauma.Findings: A post-mortem examination revealed 200 cc of clotted blood in the pericardium, indicating cardiac tamponade, alongside a visible rupture on the posterior aspect of the heart. Histopathological evaluation confirmed a 1.5 cm slit-like tear on the posterior left ventricular free wall, classified as a Becker Type I rupture. Microscopic analysis of the myocardium revealed extensive hemorrhage, coagulative necrosis of myocardial fibers, and dense neutrophilic infiltration, which established acute myocardial infarction as the underlying cause. Notably, the patient had not received any prior reperfusion therapy.Conclusion: This case highlights the importance of considering cardiac rupture secondary to acute myocardial infarction in the differential diagnosis for sudden, unexplained death, particularly in hypertensive patients. Furthermore, the absence of reperfusion therapy in this case underscores the critical role that timely medical intervention plays in preventing fatal mechanical complications.