LDH: 600 U/L; CK: 400 U/L; AST: 85 U/L. What is the most likely diagnosis?

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When tissue is damaged, specific enzymes spill into the bloodstream, and the pattern of which enzymes are elevated points to the affected tissue. Creatine kinase rises with muscle injury, and the cardiac-specific CK-MB isoform strengthens the signal for heart muscle involvement. LDH also increases with tissue damage, including the heart, while AST can rise in both liver and muscle injury, including myocardial injury. The combination of a moderate CK elevation together with a relatively higher LDH and AST elevation is most consistent with cardiac muscle injury rather than liver or chronic muscle disease. Hepatic injury would usually show a more prominent AST/ALT rise with less emphasis on CK, and muscular dystrophy typically presents with much higher and more chronic CK elevations. Hence, the pattern most strongly points to an acute myocardial infarction.