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Biochemical evidence of myocardial injury after severe head trauma
Insights
Severe head trauma in patients causes elevated creatine kinase (CK) and myocardial isoenzyme (CK-MB) levels, indicating heart muscle damage. Electrocardiogram (ECG) abnormalities were also common, suggesting a link to excessive catecholamine release.
Area of Science:
- Neurology
- Cardiology
- Biochemistry
Background:
- Severe head trauma can lead to significant physiological stress.
- Cardiac complications following neurological injury are a concern in clinical practice.
Purpose of the Study:
- To investigate myocardial damage in patients with severe head trauma.
- To analyze serum creatine kinase (CK) and CK-isoenzyme (CK-MB) levels and electrocardiogram (ECG) changes.
Main Methods:
- Measured serum CK and CK-MB levels in 30 patients with severe head trauma.
- Recorded serial ECGs for all patients.
- Analyzed data for patterns and correlations.
Main Results:
- All patients had elevated total CK levels.
- 28 patients showed elevated CK-MB, with prolonged elevation for at least 3 days post-injury.
- 90% of patients exhibited prolonged corrected QT interval (QTc) on ECG, with 53% showing nonspecific ST segment and T wave changes.
Conclusions:
- Severe head injury is associated with ongoing myocardial damage, evidenced by elevated CK-MB.
- Observed ECG abnormalities are consistent with neurological disorders.
- Excessive catecholamine release is the probable mechanism for cardiac damage and ECG changes in these patients.
Abstract:
Serum levels of creatine kinase (CK) and its myocardial isoenzyme (CK-MB) were measured and serial ECG recorded in 24 male and 6 female patients with severe head trauma. All patients were comatose, but no patient sustained a spinal or chest injury. Total CK activity was elevated in at least one sample in each patient. Elevated CK-MB activity was found in 28 patients. The serial CK-MB data did not follow the same pattern as that of patients suffering from myocardial infarctions. The mean CK-MB remained elevated for at least 3 days after injury, although individual patterns were variable. ECG abnormalities included prolonged corrected QT interval (QTc) in 90% and a variety of nonspecific ST segment and T wave changes in 53%. These ECG findings are consistent with other clinical studies of severe neurological disorders, particularly cerebrovascular accidents. The elevated CK-MB activity indicates that ongoing myocardial damage occurs in patients with severe head injury. Although the underlying mechanism is not entirely clear, an excessive release of catecholamines is the most likely mechanism accounting for diffuse myocardial damage, prolonged elevated CK-MB values and the observed ECG abnormalities.