FORENSIC MEDICAL CRITERIA FOR DIFFERENTIAL DIAGNOSIS OF SUDDEN DEATH IN ALCOHOLIC CARDIOMYOPATHY AND ISCHEMIC HEART DISEASE

Background: Cardiovascular diseases remain a leading cause of mortality globally, with alcoholic cardiomyopathy (ACM) representing a significant but often under-diagnosed challenge in forensic practice. Objective: To improve differential diagnostic criteria for sudden death caused by ACM and ischemic heart disease (IHD) using complex post-mortem analysis, including morphological, biochemical, and histological methods. Methods: A retrospective analysis of forensic reports (2015–2020) and a prospective study of 196 cases were conducted. The subjects were divided into three groups: ACM (n=93), IHD (n=33), and a control group (n=35). Techniques included quantitative morphometry of the heart, blood ethanol chemical analysis, and biochemical screening. Results: Significant differences were found in heart mass (IHD: 494.82 g vs. ACM: 392.78 g) and coronary artery stenosis (IHD: 66% vs. ACM: 15%). Histological findings showed uneven blood filling and dystrophic changes in 94-95% of ACM cases compared to 52-64% in IHD. Blood ethanol levels in ACM cases averaged 2.75‰. Conclusion: The integration of biochemical markers and precise morphometric data provides a diagnostic reliability of over 90% in distinguishing ACM from other cardiac pathologies.