Sudden cardiac death (SCD) represents one of the most challenging entities in forensic and medicolegal practice due to its abrupt onset, absence of prior symptoms, and potential for misinterpretation as an unnatural death. The present retrospective study was conducted in the Department of Forensic Medicine, School of Medical Sciences and Research, Sharda University, Greater Noida, covering the period from November 2010 to August 2012. A total of 196 cases of sudden natural deaths were examined, of which 64 were confirmed as sudden cardiac deaths based on detailed autopsy and histopathological evaluation. Data on age, sex, circumstances of death, cardiac lesions, and toxicological findings were analyzed. The majority of victims were males (84.4%) between 31 and 50 years of age. Coronary atherosclerosis was the most common pathological finding (62.5%), followed by myocardial infarction (43.7%) and left ventricular hypertrophy (25%). In 12.5% of cases, toxicological screening was conducted to exclude poisoning, and all results confirmed natural cardiac etiology. Most deaths occurred outside hospital settings, highlighting the diagnostic and legal importance of autopsy in establishing the true cause of death. The study concludes that ischemic heart disease is the principal cause of sudden cardiac death in the medicolegal autopsy population, particularly among middle-aged men, and that thorough postmortem examination supplemented with histopathology and toxicology is essential for accurate cause determination and for ensuring justice in medicolegal investigations.