# 2,3,5-Triphenyl Tetrazolium Chloride (TTC): A Dye to Detect Acute Myocardial Infarction in Cases of Sudden Death

## TL;DR

This study shows that TTC dye can detect early heart attacks in sudden death cases better than traditional methods.

## Contribution

Demonstrates the effectiveness of TTC staining in identifying acute myocardial infarction within four hours of sudden death.

## Key findings

- TTC staining detected early infarcts in 31 out of 62 sudden death cases.
- Histopathology confirmed only seven cases, showing TTC's superior early detection capability.
- Most TTC-positive cases (77.4%) had infarctions within 0-4 hours, undetectable by microscopy alone.

## Abstract

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.