CARDIAC CONTUSION AND CREATINE KINASE-MB - A PERTINENT CASE-HISTORY AND BRIEF REVIEW OF THE UTILITY OF CK-MB

Cardiac contusion is defined as the myocardial cellular damage that ca n result from nonpenetrating chest trauma. However the noninvasive dia gnosis of this lesion is problematic. Among the criteria suggested for the diagnosis of cardiac contusion is an elevation of serum levels of the heart-specific isoform of the enzyme creatine kinase (CK-MB). We present here the case of a patient who, on the basis of an initial ele vation of CK-MB, was suspected of having cardiac contusion as a result of a motor vehicle accident. The patient was clinically stable and th ere were no other signs to support this diagnosis. Serial analyses sho wed a fall in total CK to below the upper limit of the reference inter val but, as a percent of total activity, CK-MB was constantly slightly elevated (values 5.1-6.5%, upper limit of normal = 4%). At the same t ime the patient appeared to be improving clinically. The patient's sta tus deteriorated suddenly and he eventually went to surgery where a la rge intramural haematoma and a left ventricular aneurysm were discover ed. The significance of the elevations of serum CK-MB is discussed and a brief review of the literature is presented.