Objective - a morphological study of myocardial tissue was carried out in order to characterize the metabolic lesions that influence the heart contractility in cases of
sudden cardiac death from
alcoholic cardiomyopathy. The occurrence of metabolic damages in myocardial tissue in cases of
alcoholic cardiomyopathy is a vivid reflection of the toxic effects on the cardiac muscle of
ethanol and its metabolites. The toxic damage of the main structural components of the microcirculatory vessels contributes to the disruption of the transport of
electrolytes and nutrients with the development of trophic disorders and the increasing phenomena of
hypoxia that is the cause dystrophic and necrobiotic changes in myocardial tissue. The
contracture damages of cardiomyocytes, intracellular myocytolysis, and cationic decomposition of myofibrils were revealed in polarized light and they were mosaic in nature and played a direct role in the occurrence of cardiac rhythm disturbances. An immunohistochemical study of
desmin expression can be recommended as a marker of ischemic and necrobiotic changes in cardiomyocytes, that development is possible on the background of subtotal concentrations of
ethanol in the blood. The results of a morphometric study of the parenchymal component of myocardial tissue have established that the relative area of the parenchyma is not directly related to the age and gender of those who died from
alcoholic cardiomyopathy. It is recommended to use a combination of morphological methods including light microscopy, polarization microscopy methods and immunohistochemical method for the diagnosis of
alcoholic cardiomyopathy in forensic practice.