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Changes in whole body hormonal and metabolic bal-ance accompany acute myocardial infarction (AMI) as well as other types of injury, including surgical trauma. Since these changes may elicit arrhythmias or influence the extent of infarcted myocardial tissue, they have been the subject of a major research effort during recent years. We have attempted a brief and selective review of this field, especially as it relates to the general theme of this symposium. HORMONAL A N D METABOLIC RESPONSE Both plasma adrenaline and noradrenaline are mark-edly elevated within a few hours of the onset of pain. Although the response is individually variable, it is roughly proportional to the severity of illness. ' It is associated with an early suppression of insulin secretion