ABSTRACT context: Evaluation of cardiac autopsy specimens is crucial for identifying concealed cardiovascular pathology and providing insights into the pathogenesis and progression of disease. Hence, this study was undertaken to evaluate the histopathological features of cardiac lesions in autopsy specimens. method: The was a prospective cross-sectional study conducted on cardiac specimens from routine autopsies over a period of three and half years, between January 2018 and June 2021, at M.S. Ramaiah Medical College and Hospitals, Bengaluru. The hearts were evaluated grossly and microscopically to identify the various histopathological changes. results: A total of 250 cases, with mean age of 39±15 years and male-female ratio of 4.4:1, were evaluated. In 207 (82.8%) cases 299 morphological lesions were identified, comprised of coronary atherosclerosis (52.4%), myocardial infarction (26%), aortic atherosclerosis (21.2%), cardiac hypertrophy (12%), valvular disease (2%), aortic dissection (2%), cardiac tamponade (1.6%), pericarditis (1.2%), myocarditis (0.8%) and cardiomyopathy (0.4%). conclusion: Cardiac lesions were detected in 82.8% in autopsies. The most frequent finding is coronary atherosclerosis with triple vessel involvement being the commonest. Severe luminal occlusion, calcification and thrombosis are most frequent in Left anterior descending coronary artery. The next most common lesion is Myocardial Infarction, the most significant pathogenetic mechanism of which is coronary atherosclerosis. There is a strong association between coronary and ascending aorta atherosclerosis. Thus, many preventable and concealed lesions are discovered at cardiac autopsies and this data is important for assessing disease trends and introducing new interventions and therapeutic management regimes