Abstract

Introduction: Acute myocardial infarction is a most common cause of sudden death. Microscopic evidence of infarction is seen in H & E stained section only if person survived for a minimum period of 6 hours after fatal ischemic attack. So for visualisation of infarct of lesser age TTC test can be used. It is a gross staining procedure which can reveal infarct of within 5–6 hrs. age Aim of this study to incorporate this test in study protocol of sudden cardiac death with aim of visualising infarct rather than giving indirect evidence. Objective: To study usefulness of TTC stain as indicator of early myocardial infarction in Autopsy cases. Materials and Methods: The present study was conducted in MGM Medical College Indore on 210 Post-mortem autopsy cases of death due to suspected myocardial infarction. Heart obtained from autopsy cases subjected to gross examination of all three coronary vessels. After cleaning heart, complete transverse slices of ventricular myocardium subjected to TTC macro test. Knife cut slice is dipped in 1% solution of TTC for 20–30 minute. Result: Out of 210 cases brought for post-mortem examination with history of suspected cardiac attack on which TTC stain applied over heart 60 cases were found to show TTC staining reaction. In these cases, it was infracted area show pale to pink and normal areas as bright red. Discussion: Due to the absence of gross and microscopic changes before 6–8 hrs. of post MI survival time, there was a majar hurdle in estabilishing the cause of death by light microscopy in cases of early death due to myocardial infarction. Since biochemical alteration occur following injury to any tissue form pathological changes. After myocardial infarction due to leakage of multiple dehydrogenases enzymes infarcted area did not react with TTC and remain pale and normal myocardial enzyme react with TTC and form Formazone which was bold colour.

• 1.   Marvin M, Nachlas and Theodor K Shnitka, et al. Macroscopic Identification of Early Myocardial Infarcts by Alterations in Dehydrogenase Activity. Am J Pathol. 1963Apr;42(4):379–405.
• 2.   Lt Col RB Kotabagi, Dr (Mrs) VV Apte, Col PR Pathak, et al. Post-mortem diagnosis of early myocardial infarction-MJAFI. 2000 Apr;56(2):99–102.
• 3.   Ramesh, K Kundal, DS Bhullar, et al. The autopsy diagnosis of early myocardial infarction (mi) bytriphenyltetrazolium chloride (ttc) or nitrobluetetrazolium (nbt) dye.test. J Punjab Acad Forensic Med Toxicol. 2012;12(1):60–1.
• 4.   Knight B. Early myocardial infarction. Practical methods for its post mortem demonstration. J Forensic Med. 1967Jul–Sep;14(3):1017.
• 5.   Lie JT, Pairolero PC, Holley KE, et al. Macroscopic enzyme-mapping verification of large, homogeneous, experimental myocardial Infarcts of predictable size and location in dogs. J Thorac Cardiovasc Surg. 1975 Apr;69(4):599–605.
• 6.   Nydick I, Wr6blewski F, and Ladue JS, et al. Evidence for increased serum glutamic oxalacetic transaminase (SGO-T) activity following graded myocardial infarcts in dogs. Circulation. 1955;I2:161–8.
• 7.   Redetzki M, Ruskin A, Nowinski W, et al. Changes in enzyme activity (glutamic oxaloacetic transaminase,lactic dehydrogenase, cytochrome C and cytochrome oxidase) inserum and heart muscle after experimental myocardial infarction in the dog.Texas Rep Biol & Med. I958;16:101–115.
• 8.   Ruegsegger P, Nydick I, Freiman A et al. Serum activity patterns of glutamic oxaloacetic transaminase, glutamic pyruvic transaminase and lactic dehydrogenase following graded myocardial infarction in dogs. Circulation res.1959;7:400–410.
• 9.   Jennings RB, Kaltenbach JP and smetters GW, et al. Enzymatic changes in acute myocardial ischemic injury. Glutamic oxaloacetic transaminase, lactic dehydrogenase, and succinic dehydrogenase. Arch Path. I957;64:10–I6.
• 10.   Hamolsky MW and Kaplan NO. Measurements of enzymes in the diagnosis of acute myocardial infarction. Circulation. I96I;23:102–10.
• 11.   Strandjord PE, Thomas KE and White IP, et al. Studies on isocitric and lactic dehydrogenases in experimental myocardial infarction. J CGin Invest. I959;38:2111–118.
• 12.   Graves MD, Koepke JA, Lafond DJ et al. Myocardial enzymes in myocardial infarction. Am J Clin Path. I962;37(16):282–88.