MODERN ASPECTS OF FORENSIC MEDICAL DIAGNOSIS OF SUDDEN CARDIAC DEATH IN ALCOHOL AND DRUG ABUSERS

Abstract

General Background: Sudden cardiac death (SCD) remains a leading cause of mortality worldwide, particularly among individuals with alcohol and drug abuse disorders. The absence of pathognomonic signs complicates forensic medical diagnosis, making it a crucial and challenging issue in forensic science. Specific Background: Alcohol and drug abuse contribute to severe cardiovascular damage, leading to secondary toxic dilated cardiomyopathy, left ventricular dysfunction, and myocardial structural alterations. These changes create electrical instability in the heart, increasing the risk of fatal arrhythmias and asystole. Knowledge Gap: Despite the established relationship between substance abuse and cardiac pathology, the specific morphological markers of ventricular fibrillation and their role in SCD remain insufficiently studied. A comprehensive forensic approach to identifying these markers is needed to improve diagnostic accuracy. Aims: This study aims to analyze forensic medical literature on SCD among alcohol and drug abusers to identify key morphological markers and mechanisms underlying cardiac fatality. Results: The findings indicate that forensic diagnosis of SCD in alcohol and drug abusers is complicated by the heterogeneity of myocardial damage, the presence of fibrosis and thrombotic changes, and the absence of distinctive pathological signs. Key indicators include dilated heart chambers, epicardial obesity, and myocardial microvascular alterations. Novelty: The study provides a systematic review of forensic morphological markers of cardiac pathology in substance abusers, contributing to the improvement of forensic medical diagnostics. Implications: These findings emphasize the need for standardized forensic protocols and advanced histological and biochemical analyses to enhance the reliability of SCD diagnosis in cases involving substance abuse. Further research should focus on developing precise postmortem diagnostic criteria to differentiate SCD due to cardiac pathology from other sudden death causes.