**1. Introduction**

Cardiac troponins (cTn) T (cTnT) and I (cTnI) are the gold standard biochemical markers used to identify acute cardiac pathologies in patients who present with typical and atypical chest pain to the emergency department. These muscle-associated proteins confer superior diagnostic and prognostic ability compared to conventional nonspecific muscle derived enzyme markers such as creatine kinase (CK), its MB isoform (CK-MB), or myoglobin. Cardiac troponin determination is central to the diagnosis of non-ST segment elevation acute myocardial infarction (NSTEMI), contributing to international guidelines for diagnosis and management of NSTEMI patients [1].

Recent advancement in laboratory technology driven both by clinical demand and the commercial *in vitro* diagnostic market has seen the emergence of highly analytically sensitive immunoassays for the termination of cTnT and cTnI in biological samples, mainly serum and plasma. The role out and increasing popularity of the sensitive methods have introduced new clinical challenges, notably defining acceptable reference intervals in the apparently healthy population, sex-specific cut-off values and novel clinical roles in non-acute cardiac diseases where often secondary underlying cardiac disease is present [2].

One area of interest has been the potential value of cTnT and cTnI in the postmortem setting and may provide insight into the cause of death. Troponin analysis in postmortem blood and pericardial fluid during autopsy investigations can potentially help medical examiners and forensic pathologists attribute what happened before, during, and after a death. This chapter will explore the use of cardiac troponin in the postmortem setting, from its application in routine hospital as well as medico-legal autopsy and forensics, assessing the usefulness in offering a clearer picture of an individual's final moments.
