What makes it worse is Sanchez's expression: it's completely blank during the entire death scene, and he actually takes the time to let Krest know he's screwed by showing him the axe he uses to destroy the pipe for a few seconds.
Let's not forget Dario (Played by none other than Benicio Del Toro) and his run in with a cocaine grinder. You don't see it, but blood-dyed cocaine dust and a vivid imagination can fill in the details. Well, he did deserve it for raping and killing Felix Leiter's wife.
The music accompanying this scene sounds like it came from a horror movie.
Sanchez feeding Leiter to a shark and Dario informing him that he raped Della. Especially after Bond visits the now-empty house and sees everything destroyed and Della's dead body on the bed, eyes still open.
Sanchez's Establishing Character Moment at the beginning of the film: killing his mistress's lover (and cutting his heart out, to boot) and then whipping her, made even worse by the downright ominous music, and his Faux Affably Evil tone. Not to mention the scream the guy makes as his heart is cut out.
Sanchez himself is pretty terrifying, if it's when he's being Faux Affably Evil, or when he goes into a rage (which he does very often). But when he undergoes his Villainous Breakdown near the end of the film, it really peaks.