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Related Experiment Videos

Cardiac enzyme changes in myxedema coma.

P E Hickman, W Silvester, A A Musk

    Clinical Chemistry
    |April 1, 1987
    PubMed
    Summary
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    Elevated plasma enzymes like creatine kinase (CK) and lactate dehydrogenase (LD) in patients with myxedema and hypothermia can be misleading. These enzyme changes may not indicate myocardial infarction but rather the underlying conditions.

    Area of Science:

    • Biochemistry
    • Clinical Medicine
    • Endocrinology

    Background:

    • Myxedema coma and hypothermia are critical conditions associated with metabolic disturbances.
    • Elevated plasma enzyme levels, including creatine kinase (CK), aspartate aminotransferase (AST), and lactate dehydrogenase (LD), are often observed in critically ill patients.
    • Distinguishing cardiac from non-cardiac causes of enzyme elevation is crucial for appropriate patient management.

    Observation:

    • A 74-year-old male patient presented with myxedema and hypothermia.
    • The patient exhibited significantly increased plasma activities of CK, AST, and LD.
    • Notably, CK-MB isoenzyme constituted up to 20% of total CK, and LD1 isoenzyme proportions were also elevated.

    Findings:

    • Despite elevated CK-MB and LD1, there was no clinical or investigational evidence of myocardial infarction.

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  • The observed enzyme and isoenzyme profile changes were potentially attributable to the coexisting myxedema coma and hypothermia.
  • This case highlights the non-specific nature of certain enzyme elevations in the context of severe physiological stress.

    • Implications:

    • Plasma enzyme and isoenzyme analysis in patients with myxedema and hypothermia requires careful interpretation.
    • Elevated CK-MB and LD1 should not be automatically presumed to indicate myocardial infarction in these specific clinical scenarios.
    • Clinicians should consider myxedema coma and hypothermia as potential causes for these biochemical abnormalities, avoiding unnecessary cardiac interventions.