The Annals of Thoracic Surgery, Vol 43, 279-284, Copyright © 1987 by The Society of Thoracic Surgeons
Serum creatine kinase and lactate dehydrogenase isoenzyme levels in patients after major esophageal surgery, esophageal dilation, and acute myocardial infarction
GM Graeber, RE Wolf, RK Wong, DJ Cohen, BA Grishkin, LF Johnson and R Zajtchuk
All three isoenzymes of creatine kinase (CK), including MB, the fraction
used in diagnosing acute myocardial infarction (AMI), have been found in
the esophagus. Clinical reports suggest that injuries to the esophagus can
cause changes in peripheral serum CK. This prospective study was designed
to delineate whether esophageal dilation or major esophageal surgery would
cause changes in serum CK and lactate dehydrogenase isoenzymes that might
be consistent with the diagnosis of an AMI. Two groups of patients admitted
to a coronary care unit were used as controls: patients with
electrocardiographically proved AMI and those who had chest pain but who
had AMI ruled out by sequential electrocardiograms. The coronary care unit
patients had serum enzymes determined on admission, then every 8 hours for
four samples, and then daily for 3 days. The surgical patients had
determinations preoperatively, in recovery, every 8 hours for four samples,
and daily for 5 days. The patients who had esophageal dilations had serum
enzyme levels drawn before the procedure and every 8 hours for 2 days after
dilation. Serum total CK and lactate dehydrogenase levels were determined
by automated spectrophotometry. Isoenzyme levels were determined by agarose
gel electrophoresis. The data suggest that small serum CK-MB bands that may
be generated by esophageal surgery or dilation can be differentiated from
those seen in AMI and that AMI can be confirmed by simultaneous analysis of
serum lactate dehydrogenase isoenzymes.
