<prompt> The following Flipped pattern of LDH blood levels are seen in Myocardial infarction:LDH1LDH3LDH3LDH1LDH2LDH1LDH1LDH2  <response>: D LDH1LDH2?Lactate Dehydrogenase LDHoRises within 24 to 48 hours of MIoPeaks at 3 - 5 days and returns to baseline by 7-10 daysoUsefulness in patients who are admitted to hospital 2-3 days after onset of symptomsoLevel of LDH-1 greater than LDH-2 myocardial necrosisoNormally, the level of LDH-2 Is higher than the LDH-1. 29-39 of total activity against 14-26oAn LDH-1 level higher than that of LDH-2, a phenomenon known as flipped LDH, is strongly indicative of a myocardial infarction.oThe flipped LDH usually appears within 12-24 hours after a heart attack.oA normal LDH-1LDH-2 ratio is considered reliable evidence that a heart attach has not occurred.?In normal serum, LDH2 H3 M predominant isoenzyme LDHs is rarely seen.oIn myocardial infarction, LDH1 H4 levels are greater than LDH2 , called flipped pattern.oMegaloblastic anemia 50 times upper limit of LDH1 LDH2 .oMuscular dystrophy, LDH5 M4 is increased.oToxic hepatitis with jaundice 10 times more LDH5 oMyocardial infarction LDH1LDH2oMegaloblastic anemia... Marked in LD activity-Up to 50 times the upper reference limit - ineffective-Erythropoiesis - release of LD1 LD-2 isozymes.oLactate dehydrogenase, tetrameric enzyme with 4 subunits,o4 Subunits with 2 isoforms - H isoform Heart M isoform Muscle-Heart RBCs - LDH-1 4H;-Reticuloendothelial system - LDH-2 3H1M-Lungs - LDH-3 2H2M-Kidneys, placenta, pancreas - LDH-4 1H3M-Liver striated muscle - LDH-5 4MoUses:-LDH levels are more in RBC-Helpful in assessment of HemolysisTissue breakdownoFlipping effect:-Usually LDH 2 in predominant in serum LDH 1 is predominant in heart-Higher levels of LDH 1 than LDH 2 Flipped pattern is suggestive of myocardial infarction-Damaged cardiac tissues release LDH 1 into bloodstream. 