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

Abstract

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. © 1973, The Japanese Circulation Society. All rights reserved.