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Postmortem diagnosis of myocardial disease by enzyme analysis of pericardial fluid
Insights
Cardiac enzyme levels in pericardial fluid can help diagnose acute myocardial injury. Elevated enzymes were found in cardiac deaths and trauma victims, suggesting stress cardiomyopathy.
Area of Science:
- Forensic Pathology
- Cardiology
- Biochemistry
Background:
- Acute myocardial injury is a critical cause of death.
- Accurate postmortem diagnosis of cardiac events can be challenging.
- Cardiac enzyme analysis in pericardial fluid is an underutilized diagnostic tool.
Purpose of the Study:
- To evaluate the utility of creatine kinase (CK) and lactate dehydrogenase (LDH) isoenzymes in pericardial fluid for diagnosing acute myocardial injury.
- To differentiate cardiac from noncardiac causes of death using pericardial fluid enzyme activity.
- To investigate potential catecholamine-mediated myocardial injury in trauma fatalities.
Main Methods:
- Prospective study measuring CK, LDH, and isoenzyme activities in pericardial fluid.
- Comparison of enzyme levels between cardiac deaths, noncardiac deaths, and trauma victims.
- Correlation of enzyme levels with cause of death and potential myocardial stress.
Main Results:
- Significantly elevated CK and LDH levels in pericardial fluid were observed in cardiac deaths compared to noncardiac deaths.
- Trauma victims with extracardiac injuries exhibited higher enzyme elevations than those in acute cardiac deaths.
- Findings suggest stress cardiomyopathy as a physiological response to trauma.
Conclusions:
- Pericardial fluid cardiac enzyme measurements are valuable for postmortem diagnosis of acute myocardial injury, especially when histology is inconclusive.
- This method can aid in identifying myocardial injury as a contributing factor in various causes of death.
- Elevated enzymes in trauma suggest a role for stress-induced cardiomyopathy in fatalities.
Abstract:
The authors measured the activities of CK, LDH, and their isoenzymes in pericardial fluid to determine their usefulness in evaluating acute myocardial injury. Their prospective study reveals that these enzymes significantly are elevated in cardiac deaths in contrast to fatalities from noncardiac causes. Also, a group of healthy individuals who were victims of violent deaths and died from extracardiac injuries had enzyme elevations greater than those found in acute cardiac deaths, suggesting catecholamine-mediated myocardial injury (stress cardiomyopathy) as part of the physiologic response to trauma. Measurements of cardiac enzymes in pericardial fluid may prove useful in establishing the postmortem diagnosis of acute myocardial injury in instances when such injury is suspected but cannot be established by ordinary histologic methods. Studies such as this may help in defining the participation of myocardial injury as one of the lethal mechanisms in various causes of death.