POST MORTEM DIAGNOSIS OF EARLY MYOCARDIAL INFARCTION

Area of Science:

• Forensic Pathology
• Cardiovascular Pathology
• Toxicology

Background:

• Acute Myocardial Infarction (AMI) is a common cause of sudden death.
• Diagnosis often relies on indirect evidence like coronary artery narrowing (≥75%).
• Traditional H&E staining requires at least 6 hours post-infarction for microscopic evidence.

Purpose of the Study:

• To introduce and advocate for the use of novel laboratory methods for early myocardial infarction detection.
• To enable visualization of infarcts in cases of sudden death.
• To supplement or replace indirect diagnostic evidence with direct visualization.

Main Methods:

• Triphenyl Tetrazolium Chloride (TTC) Macro Test: A gross staining procedure.
• Acridine Orange Fluorescence Study: A UV fluorescent microscopic examination.

Main Results:

• TTC Macro Test can detect infarcts as early as 5-6 hours post-infarction.
• Acridine Orange Fluorescence Study can detect infarcts as early as 2 hours post-infarction.
• These methods provide direct visualization of myocardial damage.

Conclusions:

• Forensic pathologists should incorporate TTC and Acridine Orange tests into sudden death investigation protocols.
• These techniques allow for earlier and more direct diagnosis of myocardial infarction.
• Visualizing infarcts improves diagnostic accuracy compared to relying solely on coronary artery stenosis.