Objective: To explore the correlation between myocardial enzyme levels and the frequency and severity of emotional attacks in female patients with bipolar disorder (BD), and to analyze the key factors affecting myocardial enzyme abnormalities. Methods: A retrospective study was conducted on 80 female BD patients admitted to our hospital from January 2022 to August 2025. They were divided into manic episode group (32 cases), depressive episode group (30 cases), and mixed episode group (18 cases) based on the type of emotional attack. Detect the serum myocardial enzyme profiles of all patients, including creatine kinase (CK), creatine kinase MB (CK-MB), lactate dehydrogenase (LDH), and alpha hydroxybutyrate dehydrogenase (alpha HBDH). Evaluate their Hamilton Depression Rating Scale (HAMD-17) scores and Young Mania Rating Scale (YMRS) scores, and record the total number of emotional episodes in the past year. Analyze the correlation and influencing factors between myocardial enzyme levels and the frequency and severity of emotional attacks. Results: The levels of CK and CK-MB in the manic episode group were significantly higher than those in the depressive episode group and the mixed episode group, with the highest levels of LDH and α - HBDH in the mixed episode group (P<0.05); The HAMD-17 score was highest in the depressive episode group, the YMRS score was highest in the manic episode group, and the total number of emotional episodes was highest in the mixed episode group (P<0.05); The levels of serum CK and CK-MB are positively correlated with the total number of emotional attacks. CK, CK-MB, LDH, and α - HBDH are positively correlated with YMRS scores (P<0.05), but not significantly correlated with HAMD-17 scores (P>0.05); The YMRS score and total number of emotional attacks in the high CK level group were significantly higher than those in the low CK level group within the past year (P<0.05); The results of multiple linear stepwise regression analysis showed that YMRS score and total number of emotional attacks were independent factors affecting the serum CK level of BD patients (P<0.05). Conclusion: In female patients with BD, the severity of manic symptoms and frequency of emotional episodes are independent correlated factors with elevated levels of myocardial enzymes, especially CK levels. Monitoring myocardial enzymes may help assess the severity of mania and disease activity in patients.