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Question #140 (1/23/2026)

National Association of Medical Examiners 
Educational Activities Committee

Submitted by Dr. Lorenzo Gitto (Assistant Medical Examiner, Research Director, Cook County Medical Examiner’s Office and Chair of the NAME EAC Committee).
1.A 90-year-old man with a history of hypertensive atherosclerotic cardiovascular disease and diabetes mellitus was found unresponsive on the floor of his closed garage approximately three hours after arguing with his wife. He had worked as a car mechanic for 50 years. Multiple sealed and opened mechanic supplies used for automotive work were found in the garage, and opened bottles of amlodipine and glimepiride were found in his pockets. The environmental temperature was approximately 41°F (5°C). He was transported to the hospital, where he coded and died shortly after arrival despite resuscitation efforts. Postmortem examination revealed florid lividity, no trauma, diffuse atherosclerosis, an abundant amount of dense, black, odorless, thick material coating the mucosa, and diffuse organ congestion. A STAT carbon monoxide test was negative and toxicology is pending.

The autopsy finding shown in the photo is most consistent with which cause of death?