Creatine kinase levels in acute aortic dissection
Creatine Kinase Levels in Acute Aortic Dissection Acute dissection of the aorta is often misdiagnosed because the clinical presentation may mimic that of other diseases. The definitive diagnosis of acute aortic dissection is established by aortography. Other diagnostic procedures include magnetic resonance imaging, Doppler echocardiography and computed tomography.
Davidson and colleagues analyzed whether determination of serum creatine kinase isoenzyme levels would aid in the differential diagnosis of chest pain. Serum creatine kinase levels were determined in 22 patients with an established diagnosis of acute dissection of the aorta. All but one of the patients were men; ages ranged from 39 to 76 years (mean: 60 years). Acute chest pain was the admitting complaint in all of the patients. The pain was confined to the chest in ten patients and radiated to the back in six patients. In the remaining six patients, abdominal pain and chest pain were present.
Serum creatine kinase levels were more than 50 percent above normal in 14 of the 22 patients. Creatine kinase isoenzyme determinations were obtained in five patients. In each patient, creatine kinase-MM was found to constitute over 95 percent of the total creatine kinase level. Such high levels of creatine kinase-MM are usually found only in association with skeletal muscle injury. One possible explanation for the elevation in patients with acute dissection of the aorta may be that interruption of the blood supply led to injury of skeletal muscle.
Total serum creatine kinase levels may be elevated in both acute myocardial infarction and acute dissection of the aorta. However, the authors believe that identification and quantification of the specific creatine kinase isoenzyme levels may help differentiate these two conditions. (Archives of Internal Medicine, October 1988, vol. 148, p. 2184.)
COPYRIGHT 1989 American Academy of Family Physicians
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