Myocardial fibrosis, myocardial sclerosis and ‘myocardiocoronary sclerosis’ in autopsy diagnosis

01 / Abstract

Context and purpose.

In Romanian medico-legal practice, diagnoses such as ‘myocardial fibrosis’, ‘myocardial sclerosis’ or ‘myocardiocoronary sclerosis’ are used relatively often to explain sudden deaths. Contemporary literature confirms that myocardial fibrosis may provide an important structural substrate for malignant ventricular arrhythmias and sudden cardiac death, but this relationship depends on the type, extent, distribution and aetiology of the fibrosis.

This paper distinguishes replacement fibrosis from interstitial or reactive fibrosis and argues that morphological findings must be integrated with the circumstances of death, clinical history, coronary anatomy, toxicology and complementary investigations. ‘Myocardial fibrosis’ should be used as a descriptive, characterised finding, whereas unqualified traditional diagnoses may create an appearance of causal certainty.

02 / Key findings

Conclusions to retain.

1. 01The microscopic presence of fibrosis alone does not prove that it caused death.
2. 02A large post-ischaemic scar and certain non-ischaemic scars may constitute major arrhythmogenic substrates.
3. 03Type, severity, distribution and probable aetiology should be described separately from the conclusion about the mechanism of death.
4. 04Coronary disease and myocardial injury must be documented separately before a causal relationship is formulated.

03 / Structure

What the paper examines.

1. 01Terminological problem
2. 02Myocardial fibrosis as a heterogeneous morphological entity
3. 03Mechanisms by which fibrosis may promote sudden death
4. 04Lessons from contemporary autopsy studies
5. 05Romanian data and the problem of specificity
6. 06Coronary atherosclerosis and apparent certainty
7. 07Limits of autopsy in arrhythmic death
8. 08A practical hierarchy of relevance to the mechanism of death
9. 09Proposed terminology for autopsy diagnosis
10. 10Conclusions and references

04 / Full paper

Read or download.

The complete scientific paper, including its tables, conclusions and references, is available in Romanian.

05 / Citation and use

Suggested reference.

Chiriac S. Myocardial fibrosis, myocardial sclerosis and ‘myocardiocoronary sclerosis’ in autopsy diagnosis. Scientific review material. September 2026.

Scientific and educational review material. Substantial reproduction requires acknowledgement of the source; conclusions must be interpreted in the full context of the paper and its references.