Pathologic detection of early myocardial infarction: A critical review of the evolution and usefulness of modern techniques

The limitations of post mortem detection of early myocardial infarction by hematoxylin and eosin staining stimulated a search for the development of i mproved diagnostic methods based on biochemical and morphologic changes. Me thods used and/or investigated included electron microscopic examination, g ross and microscopic histochemical stains (tetrazolium salts, phosphotungst ic acid-hematoxylin, trichrome, periodic acid-Schiff, hematoxylin-basic fuc hsin-picric acid), fluorescence, immunohistochemical. techniques, anal chem ical analysis of pericardial fluid. This practical review, designed for bot h forensic and hospital-based autopsy pathologists, examines the methods av ailable for post mortem diagnosis: of myocardial infarction for cases in wh ich death might have occurred before the evolution of changes detectable by hematoxylin and eosin staining. The status and potential usefulness of eac h adjunct to classical morphologic examination is summarized. Recent develo pments are highlighted, including the possibility of using apoptosis as a m arker for acute ischemic injury.