An 84-year-old woman was unsuccessfully resuscitated for 3 min using standard cardiopulmonary resuscitation (CPR), followed by 15 min of active compression-decompression (ACD). The autopsy revealed that death was due to myocardial infarction complicated by rupture of the infarcted area and pericardial tamponade was diagnosed. Furthermore, a series of rib fractures, a transverse fracture of the sternum, rupture of the pericardial sac, the right ventricle, both atria and lacerations of the ascending aorta, were found with no signs of a vital reaction. To our knowledge, such extensive cardiac injury after CPR has not been previously reported. It is suggested that the pre-existing pericardial tamponade, the age of the patient and the application of the ACD-device to incorrect areas of the chest contributed to the extent of the cardiac injury. This case further adds to the suspicion of an increased risk of cardiac injuries when using an ACD device for cardiac massage.