Unveiling the cause of sudden cardiac death: a macroscopic and microscopic analysis at the Institute of Forensic Medicine, Cluj-Napoca (Romania)

Sudden cardiac death (SCD) remains a critical public health problem, prompting efforts to understand its underlying causes and identify patients at risk. Despite declining cardiovascular mortality in developed nations, SCD still claims millions of lives annually, disproportionately affecting men and older individuals with a higher prevalence of ischemic heart disease. This study aimed to investigate the potential association between macroscopic and microscopic diagnoses in SCD cases based on a cohort of 3438 medico-legal autopsy reports collected at the Institute of Forensic Medicine, Cluj-Napoca, Romania, between 2014–2018. By analyzing representative heart tissue samples collected during autopsies, particularly from areas exhibiting visible abnormalities, we aimed to establish a link between macroscopic observations and microscopic confirmation. A detailed histopathological analysis on archived tissue samples focused on both ventricles, on areas with potential macroscopic indicators like myocardial ischemia, coronary atherosclerosis, and interstitial fibrosis. Standard techniques were employed to prepare tissue sections for microscopic examination, allowing for the evaluation of