Background: Sudden death (SD) is defined as an unexpected natural death within an hour onset of symptoms or unwitnessed death that occurs within 24 hours, which accounts for most cardiovascular deaths in Malaysia. This study aimed to evaluate the extent of histopathological changes in the heart and to study the demographic trend in SD cases in Kuala Lumpur, Malaysia. Methods: Specimens from all SD cases were received from 2017 to 2018 by the Forensic Unit, Hospital Canselor Tuanku Mukhriz (HCTM) were studied. The specimens were the left ventricular myocardium and left anterior descending artery (LAD), which were fixed in 10% formalin with haematoxylin and eosin staining. The tissues were graded histologically based on changes such as arterial occlusion, myocardial infarction, and/or thrombus formation. Results: Out of 545 medicolegal deaths, only 25 cases (4.6%) had samples available for analysis. Among these 25 patients, 24 (96%) were male patients and only one (4%) was a female patient. The available samples were from patients aged between 30 to 79 years old. In terms of ethinicity, Malays (40%) were the most numerous, followed by patients of Chinese and Indian ethnicities.The majority of the SD cases had a body mass index (BMI) that ranged between underweight (56%) and obese (40%). Besides, there were 10 (40%) cases of coronary artery with atheroma and 15 (60%) cases of myocardial infarction. The most common presentation of atherosclerosis was grade III and IV, and acute MI was the most common presentation at death, followed by healed infarcts and old infarcts. Discussion and Conclusion: Our findings reflect worsening risk factor levels in cardiovascular diseases, compounded by demographic trends. Further studies on biomarkers specific for cardiac diseases are warranted to understand imminent sudden cardiac death.