Abstract Background: Sudden unexplained deaths present chal-lenges for forensic pathologists as they do not deal only with traumatic deaths, but also with a wide range of natural deaths. These are mostly sudden, unexpected, clinically unexplained, or otherwise obscure deaths. The cardiovascular disorders be-ing a primary focus is the leading cause of sudden unexpected deaths (SUDs). Aim of Study: This study aimed to improve management of patients attending emergency department with AMI in acute respiratory failure cases by reviewing the cases of ALI in SUDs and define the etiology and the underlying causes among the Egyptians through conduction of comprehensive analysis of the etiological causes of deaths in cases suffered from massive lung pathology as in cases of ALI and fatal heart pathology as in cases acute myocardial infarction in 80 autopsy cases from anonymous archives of cases of sudden / unexpected death that were admitted to the EFMA in Egypt between 2009 and 2014. Material and Methods: A comprehensive autopsy analysis was conducted, focusing on the presence of AMI and ALI with-out histopathological or immunohistochemical assessments. Results: Among the subjects, 65% exhibited additional lung diseases, with approximately 35% showing signs of ALI. Notably, 60% presented with coronary artery disease, and 40% showed cardiac muscle damage. Conclusion: The findings suggest a potential association between myocardial damage and ALI in unexpected deaths. This study underscores the importance of routine cardiac eval-uation in ALI cases to rule out cardiac involvement. Further research is warranted to understand the complex relationship between AMI and ALI.