Cardiac and brain pathological alterations with potential biomarker screening in stress-related fatalities

Stress is a known contributor to fatal injury; however, the absence of reliable biomarkers complicates determining the cause of death in forensic cases where stress is implicated. To address this, we conducted a retrospective analysis of post-stress fatalities, focusing on key endoplasmic reticulum (ER) stress proteins in the cardiac and brain tissues of individuals who died from sudden coronary heart disease (CHD) or apparent stress-induced causes. Significant differences were identified between these groups in age distribution, time of death, heart weight, left ventricular wall thickness, and interventricular septal thickness. Although both groups showed similar ischemic, hypoxic, and electrophysiological alterations in the myocardium, the expression profiles of key ER stress markers in cardiac and brain tissues were markedly distinct. Therefore, this study aims to compare the expression differences of ER stress markers in cardiac and brain tissues, thereby providing clues for effectively distinguishing between sudden coronary heart disease death and stress-induced death.