Is Serum Creatine Kinase-MB in Electrically Injured Patients Predictive of Myocardial Injury?

Abstract

We undertook a retrospective study of 36 victims of high-voltage electrical contact injuries to determine the incidence and possible source of elevated creatine kinase (CK)-MB enzyme in their serum. Only two sustained myocardial infarctions (one late) according to history, electrocardiographic findings, and clinical course. Serum lactate dehydrogenase isoenzyme levels were abnormal but revealed no myocardial infarction patterns. Creatine kinase total activity, however, reached 1.5 to 1,140 times normal in 92% and the CK-MB level was abnormal in 50% despite the low incidence of myocardial damage. Skeletal muscle CK and CK-MB levels in four nonelectrically injured patients were comparable to those in normal muscle while CK and CK-MB activity was elevated in six such electrical injuries. There was a gradient in CK-MB activity with greatest CK-MB activity in "normal" muscle near the injury site, lesser amounts in border tissue, and least in the worst-injured site. We conclude that myocardial injury is uncommon in high-voltage electrical injury and skeletal muscle injured by high electrical voltage is stimulated to produce, as well as release, CK-MB.

Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients

“…In the same study, CK-MB and cTnI were not found to be higher in arrhythmic patients compared to patients without arrhythmia after EA. Several other studies also suggest that CK-MB is not a reliable marker for screening arrhythmic and cardiac complications as this can be also elevated due to skeletal muscle and soft tissue damage [17, 18]. Although cTnI is a much more sensitive cardiac biomarker than CK or CK-MB, it does not usually increase after an EA.…”

Alterations in left ventricular function assessed by two-dimensional speckle tracking echocardiography and the clinical utility of cardiac troponin I in survivors of high-voltage electrical injury

“…Previous studies have shown conflicting results concerning myocardial damage associated with high-voltage electrical injuries (8,9,12). The reasons for these differences may be related to small sample sizes and insufficient data to support the diagnosis of myocardial tissue damage.…”

Cardiac monitorization in patients with electrocution injury

“…Inclusion criteria as well as the monitoring periods were different in the published studies. The monitoring periods in the studies are usually 6 h, [12] 6-8 h [9] and 24 h. [2,4,13] Some of the studies evaluated patients exposed to high-voltage [4,7,14] or low-voltage [9,12] electricity, while others focused on both low and high voltage. [2] Electrical current disrupts the normal electrophysiological system by causing thermal and ischemic myocardial injury.…”

“…[7] Depending on the skeletal muscle damage in electrical injury, CK-MB can also increase. [14,21] According to some authors, the role of CK-MB in the diagnosis of myocardial injury is controversial if there is no pathognomonic ECG evidence of myocardial infarction. [5,13,21] Some authors emphasize the importance of the duration of the elevation of CK-MB levels.…”