Though uncommon, puncture injury to the heart can occur during cardiac resuscitation and when inserting a lifesaving drug directly into the left ventricle of the heart. Utmost precaution must be taken to avoid damaging the conduction system of the heart, particularly the nodal part, as it can cause cardiogenic shock, arrhythmia, and sudden death. Our index case report describes a 55-year-old male who was fatally injured after being hit by a truck while riding his bike. The autopsy revealed multiple puncture injuries to the atrioventricular node area of the septum, observed on both sides of the interatrial septal wall surface. Histopathological examination also showed subendocardial hemorrhage around the atrioventricular nodal area. The nature of the injuries made identification of the cause of death difficult.