This is based on a real life relative: In the late 1940s, a woman in her mid 40s just drops dead in small town USA. There’s no autopsy. The deceased had no known medical issues. What would the local [coroner or whatever] rule? In this specific case, the family has always said they heard it was a heart attack, but no one has seen the death certificate. Would the local official just likely tell the family “heart attack,” since that is the most common, since theoretically it could have been an aneurysm, PE, or stroke.
Anecdotally: In the case of my own father, who died in his sleep, there was no autopsy. The listed cause of death was “myocardial infaction,” which we all accepted, since it made sense given his medical history.
Probably whatever was the most likely way he went. If it is of “old age” it is usually heart failure. Although I have heard that the way the person died is useful for police and things but as far as most doctors are concerned there are only 4 ways to die: Suicide, Homicide, Naturally, Accident
Unless there is reason to suspect foul play (Uh, chief, there’s a hatchet in his head) or an accident, probably a “death by natural causes” type of phrase covers pretty much everything.
A man I knew when I was younger was a doctor from the 50s and 60s who lived long enough to see Quincy in television. He and I used to get itno discussions about stuff like this all the time. His usual thing was to use his knowledge of the person and their medical history to basically make a “best guess”. If a person has a specific kind of fever or specific symptoms, those were used to pick a name for cause of death. If it was a sudden and unexpected death of an otherwise healthy person, “myocardial infarction” was always popular as well as “cardiomyopathy”. It makes it a bitch when you are trying to look for possible genetic links to illnesses you have but that’s what it comes down to.
Only about 12-15% of all deaths get autopsied in the US. It’s not that common really. If there is no reason to suspect foul play or other mitigating factors (workplace exposures and such) then the cause of death is determined to best of the doctors ability based on the patient’s history.