HISTOLOGICAL

TECHNIQUE IN DIAGNOSIS
OF MYOCARDIAL
INFARCTION

- DILIP KUMAR SINGH

48th batch
Roll no. 14
MYOCARDIAL INFARCTION
(HEART ATTACK) –

Death of cardiac muscle due to ischemia

ISCHEMIA – Imbalance between supply and demand of

blood .

MYOCARDIAL INFARCTION –

1- Transmural
2- Subendocardial
 DIAGNOSIS OF
MYOCARDIAL INFARCTION

1. TYPICAL SYMPTOM
2. CHEMICAL EVIDENCE
3. ECG PATTERN

MI patients have rapid weak pulse and dyspnoea.

 DIAGNOSTIC MARKER OF
BLOOD
Based on examination of blood level of intracellular
macromolecules.

These include –
1. MYOGLOBIN
2. CARDIAC TROPONIN T &I
3. CREATINE KINASE
4. LACTATE DEHYDROGENASE
5. ASPARTATE TRANSAMINASE
1.MYOGLOBIN –
Time of peak elevation 4 to 6 hrs.
Time of return to normal level 20 to 25 hrs.
Earliest marker but not cardiac specific.

2.CARDIAC TROPONIN I –
Time of peak elevation 4 to 6 hrs.
Time of return to normal level 5 to 9 days
Early marker and cardiac specific.
3.CARDIAC TROPONIN T –
Time of peak elevation 18 to 36 hrs.
Time of return to normal level 5 to 14 days.
Cardiac specific but also elevated in other
degenerative diseases.

4.CREATINE PHOSPHOKINASE (CK-MB) -

Time of peak elevation 20 to 30 hrs.
Time of return to normal level 24 to 48 hrs.
Early marker and cardiac specific.
5.LACTATE DEHYDROGENASE-
Time of peak elevation 48 to 72 hrs.
Time of return to normal level 10 to 15
days.
Relatively late marker and cardiac specific.
 DETECTION BY HISTOLOGY
Eosinophilia of muscle cytoplasm 8 to 12 hrs.
Swelling of muscle fiber.
Cell wall become indistinct after 24 hrs.
Monocytes are deeply eosinophilic after 2 days.
Maximum conc. Of polymorph is seen 2 to 4
days nuclei disappear phagocytosis between 5
to 7 days
Collagen formation and deposition in 1 to 3 week
4th week early fibrosis in 3rd month fibrosis occur.
 Dense polymorphonuclear leucocytic
infiltrate in area of acute MI of 3 to 4 days
duration
 POST MORTEM DIAGNOSIS OF EARLY
MYOCARDIAL INFARCTION
Gross and microscopic appearance depend upon
duration of survival of patient after MI symptom .
Two methods –
1. Triphenyl Tetrazolium Chloride (TTC)-
Brick red color to intact non infracted myocardium
Infracted area – Unstained pale zone
Old infarct appears white and glistening .
TTC stain in area of necrosis
 ACRIDINE ORANGE FLUORESENCE
STUDY
Thin section of paraffin embedded
myocardial tissue are stained with acridine
orange.
In UV infracted tissue appears bright grass
green fluorescence .
Normal myocardium golden brown .
THANKS