SERUM ENZYME PATTERNS IN ACUTE ISCHEMIC HEART DISEASE WITH SPECIAL REFERENCE TO LDH ISOENZYMES IN INTERMEDIATE TYPES OF ISCHEMIC HEART DISEASE, FRESH MYOCARDIAL INFARCTION, AND CARDIOGENIC SHOCK
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The serum enzyme patterns of 50 patients with acute ischemic heart disease accompanied by chest pain were analyzed and correlated with clinical and electrocardiographic findings. Two autopsy cases are presented. 1) The patterns of SLDH isoenzymes were obtained by the author's modification of "agaragarose gel electrophoresis". 2) In patients with fresh myocardial infarction, SLDH activity and the LD5/LD4 ratio began to increase 4 hours after the attack, reached their peak in about 2 days, then gradually decreased to normal, SLDH activity in about 2 weeks, the LD5/LD4 ratio in 3 weeks, on the average. 3) In patients with angina of effort, the various serum enzymes remained within the normal range. 4) Four types of intermediate IHD were differentiated by their SLDH isoenzyme patterns: infarction type, dissociation type (H-type SLDH isoenzyme pattern without increased SLDH activity), abortive type (transient H-type pattern), and normal type. The "infarction type" and "dissociation type" were considered reflect necrosis of the heart muscle. In the "normal type", enzymological evidence suggested that the ischemic changes in the heart muscle were reversible. Only in the "abortive type" it is unknown whether or not a small area of necrosis is present. Thus, ischemic heart disease accompanied by chest pain can be more clearly subdivided into cases of necrotic and non-necrotic heart muscle by following the serial changes of the various serum enzymes, especially the SLDH sioenzyme pattern. in correlation with history, electrocardiograms, and other laboratory findings. 5) Angina of effort and the "normal type" of intermediate IHD were differentiated by serum SCPK activity. In the "normal type" of intermediate IHD, SCPK activity generally increased after the anginal attack, but in angina of effort, it remained within the normal range. Two patients with increased SCPK activity of the "normal type", had the "varrant form" of angma pectoris as described by Prinzmetal. 6) The analysis of SLDH isoenzyme patterns appears to be a very useful parameter in the rehabilitation of patients with ischemic heart disease accompanied by chest pain, but further investigations are necessary, 7) The prognosis was poor in patients with the M-type pattern of SLDH isoenzymes (i.e. increased serum LD1) unless this was due to complications with other diseases. All patients with markedly increased serum LD1 (about 30%) died. The M-type pattern of SLDH isoenzymes is very useful in the diagnosis and treatment of ischemic heart disease and probably originates chiefly from damaged liver and skeletal muscles, during acute circulatory failure. 8) In patients with severe IHD, the M-type pattern of SLDH isoenzymes tends to appear earlier than the H-type pattern. A probable explanation of this phenomenon is that the amount of hepatic tissue injured in cardiogenic shock is very large in comparison with the relatively limited lesion of the myocardium.
- 社団法人日本循環器学会の論文
- 1973-08-20
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関連論文
- CARDIAC ARRHYTHMIAS AND SERIAL CHANGES OF VARIOUS SERUM ENZYMES IN A PATIENT WITH PHEOCHROMOCYTOMAS OF BOTH ADRENALS
- CONTINUOUS ELECTROCARDIOGRAPHIC RECORDINGS AND SERIAL CHANGES OF VARIOUS SERUM ENZYMES IN A PATIENT WITH VARIANT FORM OF ANGINA PECTORIS
- SERUM ENZYME PATTERNS IN ACUTE ISCHEMIC HEART DISEASE WITH SPECIAL REFERENCE TO LDH ISOENZYMES IN INTERMEDIATE TYPES OF ISCHEMIC HEART DISEASE, FRESH MYOCARDIAL INFARCTION, AND CARDIOGENIC SHOCK