Effects of decomposition on the cardiovascular system: A systematic review

Objective: Postmortem decomposition poses significant challenges in forensic pathology, particularly in the evaluation of the heart and coronary arteries. Putrefactive processes may alter or mask cardiac pathology, complicating the interpretation of cause of death. This systematic review aims to evaluate the literature on decomposition-related alterations of the heart and vessels, focusing on their forensic impact. Method: A systematic literature review was performed across PubMed, Scopus, and Web of Science, including studies from 1970 onward. Articles were screened according to predefined criteria, and duplicates were removed using Rayyan software. After initial screening and full-text evaluation, seven original research articles and one forensic guideline were included in the final analysis. Results: The review confirmed a significant lack of focused studies on cardiac decomposition. Calcified atherosclerotic plaques remained detectable in various stages of decomposition, including skeletal remains, and may serve as reliable postmortem indicators. In contrast, myocardial histology was often unreliable due to autolysis and bacterial overgrowth. Postmortem computed tomography angiography (PMCTA) showed some capacity to visualize vascular calcifications but was hindered by postmortem gas and fluid artifacts. Mummification and adipocere cases demonstrated improved preservation of cardiac morphology, particularly of coronary arteries, though valvular structures remained difficult to assess. Conclusion: The current literature provides limited guidance on the forensic evaluation of decomposed cardiac tissues. Despite this, certain features such as vascular calcifications may retain diagnostic value. Further controlled studies are needed to develop standardized protocols for assessing postmortem cardiac pathology.