ATP: creatine phosphotransferase in the diagnosis of acute chest pain.

A common problem in clinical medicine is the diagnosis of acute chest pain. Usually, the history, clinical findings, and electrocardiographic evidence are sufficient to enable the clinician to reach a confident diagnosis. Some cases, however, have atypical features or show an electrocardiogram difficult of interpretation, because of previous infarction, left bundle-branch block, previous left ventricular strain, arrhythmias, or changes due to digitalis therapy. In such instances, the clinician may seek the aid of the clinical chemist. The laboratory methods most likely to be of assistance are assays of the activity of various enzymes which are normally present in low concentration in the serum, but in high concentration in cardiac muscle, e.g. the transaminases (aminotransferases), which are the most generally used, lactate dehydrogenase (or one of its iso-enzymes "a-hydroxybutyrate dehydrogenase "), aldolase, malate dehydrogenase, phosphohexose isomerase, and creatine kinase (ATP: creatine phosphotransferase). During a study of creatine kinase assay in clinical medicine, inter alia, the problem of the biochemical diagnosis of acute chest pain was examined. A new technique must be proved superior to the older ones before it can replace an established method. Therefore, creatine kinase (CK) was compared with two tried methods, the transaminases (SGOT, SGPT) (Karmen, Wr6blewski, and LaDue, 1955) and the "a-hydroxybutyrate dehydrogenase" (SHBD) isoenzyme of lactate dehydrogenase (Elliott and Wilkinson, 1961).