Objective — a morphological study of myocardial tissue was carried out in order to characterize the metabolic lesions that influence the heart contractility in cases of sudden cardiac death from alcoholic cardiomyopathy. The occurrence of metabolic damages in myocardial tissue in cases of alcoholic cardiomyopathy is a vivid reflection of the toxic effects on the cardiac muscle of ethanol and its metabolites. The toxic damage of the main structural components of the microcirculatory vessels contributes to the disruption of the transport of electrolytes and nutrients with the development of trophic disorders and the increasing phenomena of hypoxia that is the cause dystrophic and necrobiotic changes in myocardial tissue. The contracture damages of cardiomyocytes, intracellular myocytolysis, and cationic decomposition of myofibrils were revealed in polarized light and they were mosaic in nature and played a direct role in the occurrence of cardiac rhythm disturbances. An immunohistochemical study of desmin expression can be recommended as a marker of ischemic and necrobiotic changes in cardiomyocytes, that development is possible on the background of subtotal concentrations of ethanol in the blood. The results of a morphometric study of the parenchymal component of myocardial tissue have established that the relative area of the parenchyma is not directly related to the age and gender of those who died from alcoholic cardiomyopathy. It is recommended to use a combination of morphological methods including light microscopy, polarization microscopy methods and immunohistochemical method for the diagnosis of alcoholic cardiomyopathy in forensic practice.