Cardiac tamponade is a life-threatening emergency having both acute and a delayed presentation. In the latter there is a potential for medical practitioners to miss the diagnosis as happened in our case resulting in allegations of medical negligence. Before starting the autopsy in such cases, the forensic pathologist should try to obtain the complete treatment record and be ready to request ancillary investigations as required. We report a case of death due to cardiac tamponade caused by a penetrating injury to the heart. A feature of this case was the failure of our medical system to diagnose the condition and the legal system due to failure of the police to register the first information report under appropriate legal sections.