Extreme Elevation of Transaminase Levels in Acute Heart Disease—a Problem in Differential Diagnosis?

Abstract

Five patients admitted to the Coronary Care Unit at the Department of Medicine, Serafimerlasarettet [Stockholm, Sweden], who developed extreme elevation of transaminase levels, were discussed in terms of problems in differential diagnosis. All 5 had manifest right ventricular failure on admission and 4 also had hypotension. Three of the patients died; 2 survived. The 3 post-mortem examinations showed extensive infarctions of the left ventricle and septum. The 2 survivors had had a prolonged ventricular tachycardia and a probable silent infarct, respectively. The extremely high transaminase levels sometimes seen in acute cardiac disease were predominantly due to sizeable amounts released by the liver as a result of central necrosis of the liver cells. The probable prerequisite for the development of central necrosis of the liver in acute cardiac disease was usually the combination of right ventricular failure and hypotension, which in turn were most often due to extensive left ventricular infarcts.