Postmortem diagnosis of myocardial disease by enzyme analysis of pericardial fluid.

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.