[Histological, histochemical and x-ray angiographic studies of the blood circulation in the myocardium in cardiac infarct].

The hearts of 11 necropsy cases--nine with myocardial infarction and two with pulmonary embolia were investigated--histologically, histochemically and roentgenoangiographically. The author recommends, for the complete investigation of myocardium blood circulation, a successive filling of the heart vascular system, first of all with Indian ink-gel mass--for to follow up the microcirculation state and then--with roentgen-contrast mixture of Hauch and Tolgskaja--for to establish the changes in the large arterial vessels. Severe microcirculation disorders in the cardiac muscle were found in acute myocardial infarction, involving all heart segments, manifested with focal phenomena of stasis with ischemic changes in myofibres. With the establishment of a similar microcirculatory picture in pulmonary embolia, the author explains the differential-diagnostic difficultes in those two states. The thromb-formation in small arterial and venous vessels in those regions, developing on the background of a blood stasis with a consequent hypoxy of the vessel wall is stressed to be of importance for the intensification of the changes in the ischemic zone and for the widening of the necrotic area in case of fresh myocardial infarction. These observations support the application of anticoagulants and fibrinolytics as an important prophylactic measure against myocardial infarction in stenocardiac paroxysms and against the extension of the necrosis in an already developed infarction. The poor vascular, especially microcirculatory, network in the area of the postinfarction cicatrices is admitted to be the most likely cause for the frequent development of repeated infarctions in the preserved among and around them myofibres.