Similarities in Clinical Symptoms

A comparison of these two diseases in respect to the clinical symptoms may seem impossible at first sight. However, a few details of the syndromes in both diseases may be mentioned. The most evident symptom of toxemia of pregnancy, the elevated blood pressure, is not seen in coronary sclerosis or, at least, not to such an extent. However, according to Brown et oi. (1957), the blood pressure in coronary disease, before infarction has occurred, is slightly raised on an average, compared with that in healthy men of the same age. After the recovery from the acute phase of an infarction, the blood pressure becomes fixed at a lower level than that in the healthy controls. A regulating system to supply the tissues with blood as well as possible is certainly present and substances released from the ischemic and injured tissues must play a role. 

Bastiaanse and Mastboom, 1949 Van Bouwdijk Bastiaanse, 1954). In the latter cases the placenta also does not obtain enough blood and an ischemia will be present, while infarctions may occur as well, but the primary cause of the disease is something else, and therapy should be directed also to that. 

On the other hand, the above hypothesis does not explain how edema or albuminuria can occur before the blood pressure is raised. There nuiy be cases, however, in which the ischemia of the placenta or a possible infarct is not extensive enough to raise the maternal blood pressure immediately. Such can be expected when there is an ample supply of vessels initially. There may be pathological changes already in the composition of the blood, however. The changes in the serum protein pattern, for instance, may cause a greater inclination to develop edema, and the hormonal conditions in pregnancy also increase this tendency. 

As to edema, an inadequate supply of choline can be important (Bloem and Neumann, 1953). In one of the cases described (a nephrosis patient), the albuminuria, which was high initially, became negligible after the edema had disappeared on choline therapy. Moreover, in pregnancy, in some cases, there may be an orthostatic albuminuria as well. 

It will be clear that in cardiac infarction it is impossible to get a higher blood pressure than before, even if this should be required for the normal blood supply of the tissues. In contradistinction to pregnancy, the amount of blood or oxygen that has to be supplied does not increase. There may be only the effect of the greater force necessary to propel the blood through the vessels narrowed by atherosclerotic processes, but this effect develops very slowly and is independent of the infarction. Vascular spasms, on the contrary, may greatly increase the force necessary for blood supply of the tissues and thus increase the blood pressure. 

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