SERUM ENZYMES IN THE DIFFERENTIAL DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION

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  • Serum Enzymes in the Differential Diagn

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The paper describes the various serum enzyme patterns, the H-type of SLDH (serum lactate dehydrogenase) isoenzymes with special reference to their differences in acute myocardial infarction, cerebrovascualr disease, renal failure, and megaloblastic anemia. Characteristic differences in the patterns of change in the various serum enzymes were noted in these diseases. In the acute myocardial infarction group, the H-type pattern of SLDH isoenzymes appeared in 94.4%, and SLDH, SGOT, and SCPK activities were elevated in all cases. In the cerebrovascular disease group, the H-type pattern of SLDH isoenzymes appeared in 66.7% of the patients, and there were elevations of SLDH in 37.8%, SCPK in 69.7%, and SGOT in 43.1%. In this group, the peak values of both SCPK (serum creatine phosphokinase) and the H-type of SLDH isoenzymes were reached about 3-5 days after the onset of symptoms, and the SCPK level returned to normal more slowly. The rate of increase of total SLDH activity and the LD5/LD4 ratio of SLDH isoenzymes were generally lower than in the acute myocardial infarction group. The amount of total SLDH activity was also less and in some ceases did not increase in this group. In the renal failure group, H-type pattern of SLDH isoenzymes appeared in 33.0% of the patients, and in many cases (75% of the patients) there was an elevation of SCPK activity; the reason for this phenomenon must be investigated. The SGOT an SGPT activities remained almost within the normal range in most of the patients in this group. Both patients with megaloblastic anemia showed a clear H-type pattern of SLDH isoenzymes, but there was no elevation of SCPK, or SGOT and SGPT activities. SLDH activity, however, was normal in one case, and markedly increased in the other.

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