Microscopic analysis of hearts and revisit of medico-legally significant deaths concluded as ischemic heart disease in a tertiary care hospital in Sri Lanka

Introduction: Interestingly, the heart has the most frequent diagnostic agreement and the least refinements after histological examination. However, few studies have found a diagnostic disharmony after histological examination. In routine practice, it is usual to give the cause of death as Ischemic Heart Disease (IHD), especially with the positive clinical history and suggestive gross pathology in Sri Lanka. Objectives: We designed this study to determine the importance of microscopic findings in concluding the cause of death as IHD. Methods: A retrospective review of the autopsy reports of the cases concluded as IHD was conducted, and the cardiac sections obtained at autopsy were reviewed microscopically. Results: Among the total sample of 100 autopsies, the microscopic sections had been obtained only for academic purposes in 60% of cases where the cause of death had been concluded as IHD based on gross pathology and the clinical picture. At the microscopy review, positive histopathological findings were identified in 69%, and out of them, findings confirmed the macroscopic cause of death in 57%. In contrast, 9% had revealed a different cardiac cause of death. There were 22% autopsies with negative microscopy, even though the cause of death had been concluded as IHD based on gross pathology and clinical history. Conclusions: The study reiterates the importance of microscopy in concluding the cause of death as IHD, even though the macroscopic examination could offer crucial initial insights. The findings highlight the need for improved integration of histopathology into routine forensic practice and underscore its significance in achieving accurate cause-of-death.