D Ganesh R, Pradhan Priyadarshee
Forensic Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.
Cureus. 2024 Jul 9;16(7):e64202. doi: 10.7759/cureus.64202. eCollection 2024 Jul.
Background Cardiovascular diseases, especially ischemic heart disease, are the most frequent cause of sudden and unexpected death that constitute a significant portion of the autopsies conducted in our country. Though these deaths may be natural as well as unnatural, they carry medico-legal importance because they occur in a person who has been apparently healthy before the supervening of death, and the cause of death is difficult to ascertain. An infarction can be missed by gross and histological examination within the first few hours of sudden death. 2,3,5-triphenyl-tetrazolium chloride (TTC) is a sensitive histochemical method for diagnosing myocardial infarction within four hours of sudden death. The use of such dyes, hence, can possibly aid in ascertaining the cause of death in such cases wherein there are no known preceding factors. Aim The aim of this article was to study the occurrence of myocardial ischemia by histochemical staining method - 2,3,5-triphenyl-tetrazolium chloride (TTC). Methods This study involved patients who underwent postmortem examination in the Department of Forensic Medicine and Toxicology, Sri Ramachandra Medical College and Research Institute, Chennai. Results Of 62 cases, 31 cases were found to be positive for TTC staining, and those heart slices were subjected to histopathological examination. The maximum number of cases (77.4%) showed the age of infarction within zero to four hours, which was detected early by TTC staining compared to microscopic changes in the heart. Only seven cases were positive for myocardial infarction by histopathological examination, proving that it is difficult to detect acute infarction if the age of infarction is less than four hours. Conclusion This suggests that for all sudden death cases, 2,3,5-triphenyl tetrazolium chloride could be used as a better tool for the identification of early infarcts.
背景 心血管疾病，尤其是缺血性心脏病，是我国尸检中占很大比例的突然意外死亡的最常见原因。尽管这些死亡可能是自然的，也可能是非自然的，但它们具有法医学重要性，因为它们发生在死亡前看似健康的人身上，且死因难以确定。在猝死的最初几个小时内，大体和组织学检查可能会漏诊梗死。2,3,5-三苯基氯化四氮唑（TTC）是一种在猝死4小时内诊断心肌梗死的敏感组织化学方法。因此，在没有已知先前因素的此类病例中，使用这种染料可能有助于确定死因。目的 本文旨在通过组织化学染色方法——2,3,5-三苯基氯化四氮唑（TTC）研究心肌缺血的发生情况。方法 本研究纳入了在金奈斯里兰卡拉马钱德拉医学院和研究所法医学与毒理学系接受尸检的患者。结果 在62例病例中，31例TTC染色呈阳性，对这些心脏切片进行了组织病理学检查。最大比例的病例（77.4%）显示梗死发生在0至4小时内，与心脏的微观变化相比，TTC染色能更早检测到。组织病理学检查仅7例心肌梗死呈阳性，证明如果梗死时间小于4小时，很难检测到急性梗死。结论 这表明对于所有猝死病例，2,3,5-三苯基氯化四氮唑可作为识别早期梗死的更好工具。
