When the blade reaches the heart: A case series of fatal penetrating cardiac stab wounds

Background: Stab wounds are a major cause of homicide-related deaths. Penetrating cardiac injuries are highly lethal, with outcomes influenced by injury mechanism, physiological status, and cardiac tamponade.Aim: To analyse the forensic findings and mortality factors in fatal penetrating cardiac injuries.Materials and Methods: A retrospective review of four forensic post-mortem reports involving homicidal and self-inflicted sharp-force injuries to the heart was conducted.Results: Autopsy revealed ventricular cuts and significant haemothorax, with pleural blood volumes up to 500 mL. Death resulted from fatal haemorrhage or cardiac tamponade, with mechanisms varying according to the extent and location of injury. In cases with a retained knife, compression may temporarily limit bleeding; however, all injuries were fatal.Conclusion: Penetrating cardiac injuries have a high mortality rate. Prompt recognition and immediate surgical intervention are crucial for survival.