Creatine phosphokinase: the functioning and diagnostic capabilities of detecting myocardial contusion in patients with combined trauma

Abstract

The purpose of the investigation was to study the activity of the general and myocardial fractions of CPK in the victims with a combined trauma, one of the components of which was a blunt trauma of the thorax, during the diagnosis of myocardial contusion. The study included 50 patients with combined trauma. Myocardial contusion diagnosed in 34 patients. In 16 cases, the diagnosis of traumatic heart damage has not confirmed. The diagnosis of heart contusion based on the definition of the mechanism of trauma, the results of electrocardiographic and echocardiographic studies, and the determination of blood troponin I in blood plasma in high concentrations. The indices of central hemodynamics and the activity of the general and myocardial fractions of CPK studied. It is determined that in patients with combined trauma the activity of the general CPK is extremely high due to damage to skeletal muscles and manifestations of shock. In the conditions of increasing the activity of the total CPK, there is a regular increase in activity in the blood of myocardial CPK, which does not matter for the diagnosis of myocardial contusion. A powerful link between the shock index and the value of the total activity of CPK in the blood, as well as the activity of CPK and other indices of central hemodynamics characterizing the severity of the shock revealed. Activity of myocardial CPK in the presence of a heart contusion against the background of polytrauma is usually higher than in patients without traumatic myocardial injury, but the correct interpretation of the indicator is very difficult due to the release of a small part of myocardial CPK from damaged skeletal muscles. One of the promising areas for improving the diagnosis of myocardial contusion in patients with polytrauma is the percentage of activity of myocardial CPK relative to the total activity of CPK. The diagnosis of myocardial contusion becomes quite possible when the activity of myocardial CPK exceeds the 4% activity of the total CPK.