Changes in sympatho-adrenal and kallikrein-kinin systems in the terminal stage of extensive myocardial infarction.

Fifty patients with acute extensive myocardial infarction, with unfavourable course, were continuously survelled from the beginning of the disease till the terminal stage with the aim to study the interdependences between changes in the sympatho-adrenal and kallikrein-kinin systems in blood. The blood levels of adrenaline and noradrenaline were determined fluorometrically. The activity of the kallikrein-kinin system was estimated on the basis of three components: spontaneous esterase activity, prekallikrein activity, and kallikrein inhibitor activity in blood. Within the first six hours all patients had significantly elevated adrenaline and increased activity of the kallikrein-kinin system in blood. At 24h before death and during the terminal stage, in patients with acute heart failure and those with cardiogenic shock the adrenaline level gradually rose, and in patients with myocardial rupture the noradrenaline level increased. The activity of the kallikrein-kinin system remained elevated throughout the follow-up period. The application of findings as diagnostic and prognostic criteria in myocardial infarction is suggested.