Extreme elevation of transaminase levels in acute heart disease-a problem in differential diagnosis?

Five patients admitted to the Coronary Care Unit at the Department of Medicine, Serafimerlasarettet, who developed extreme elevation of transaminase levels, are discussed in terms of problems in differential diagnosis. All five had manifest right ventricular failure on admission and four also had hypotension. Three of the patients died, two survived. The three post-mortem examinations showed extensive infarctions of the left ventricle and septum. The two survivors had had a prolonged ventricular tachycardia and a probable silent infarct, respectively. It is concluded that the extremely high transaminase levels sometimes seen in acute cardiac disease are predominantly due to sizeable amounts released by the liver as a result of central necrosis of the liver cells. The probable prerequisite for the development of central necrosis of the liver in acute cardiac disease is usually the combination of right ventricular failure and hypotension, which in turn are most often due to extensive left ventricular infarcts.