Circulatory Dynamics in Myocardial Infarction

The clinical evidences of circulatory failure in the first days of myocardial infarction often differ conspicuously from the manifestations of decompensation in other diseases of the heart. In many instances the absence of orthopnea is striking; the patient evinces no distress when lying flat in bed despite the fact that grayish cyanosis and cold extremities testify to the impairment of the peripheral circulation. Moreover, inspection of the cervical and other superficial veins reveals that they are largely collapsed. These observations are in sharp contrast to those which one is accustomed to encounter when equally severe retardation of the peripheral circulation occurs in such conditions as, for example, mitral stenosis. In that case the patient is orthopneic, and the superficial veins are engorged. The picture in myocardial infarction is obviously the one which is familiar to every physician under the name of shock and which results from disturbances in the periphery