Biochemical assessment of acute myocardial ischaemia.
OBJECTIVE
To evaluate the efficacy of biochemical parameters in different fluids in the diagnosis of myocardial infarction of different causes, analysed after death.


METHODS
The myoglobin concentration and total creatine kinase (CK) and creatine kinase MB isoenzyme (CK-MB) activities were measured in serum, pericardial fluid, and vitreous humour from seven diagnostic groups of cadavers classified according to the severity of myocardial ischaemia and cause of death. Lactate dehydrogenase (LDH) and myosin were measured only in serum and pericardial fluid, and cathepsin D only in pericardial fluid. Routine haematoxylin and eosin and acridine orange staining were used for microscopy studies of heart tissue.


RESULTS
In pericardial fluid there were substantial differences between the different groups with respect to CK, CK-MB, and LDH activities and myosin concentrations. The highest values were found in cases with morphological evidence of myocardial ischaemia.


CONCLUSIONS
Biochemical parameters, which reach the pericardial fluid via passive diffusion and ultrafiltration due to a pressure gradient, were thus detectable in this fluid earlier than in serum in cases with myocardial ischaemia. These biochemical parameters may be of use for ruling out myocardial ischaemia in those controversial cases in which reliable morphological findings are lacking.
Perez-Cárceles
M D
MD
Department of Forensic Medicine, School of Medicine, University of Murcia, Spain.
Osuna
E
E
Vieira
D N
DN
Martínez
A
A
Luna
A
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D001826:Body Fluids / Q000737:chemistry*; D002402:Cathepsin D / Q000032:analysis; D003402:Creatine Kinase / Q000032:analysis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007527:Isoenzymes; D007770:L-Lactate Dehydrogenase / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D009206:Myocardium / Q000378:metabolism; D009211:Myoglobin / Q000032:analysis*; D009218:Myosins / Q000032:analysis; D012737:Sex Factors; D013997:Time Factors; D014822:Vitreous Body / Q000737:chemistry
D007527:Isoenzymes; D009211:Myoglobin; D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase; D002402:Cathepsin D; D009218:Myosins