[A rare cause of haematemesis with fatal gastrointestinal bleeding]. / Seltene Ursache einer Hämatemesis mit letalem Ausgang.

A 73-year-old man was admitted to the hospital due to severe hematemesis and collapse, severe anemia and inflammation. Two months ago, the patient had been treated with antibiotics due to septicemia with staphylococcus aureus. At that time CT scan had shown only thoracic arteriosclerosis. The subsequent high urgency upper endoscopy identified a circular mucosal defect in distal esophagus as bleeding origin. The patient died 10 hours after admission. Performing autopsy, a fistula between the thoracic aortic aneurysm and the distal esophagus was found in the background of severe arteriosclerosis. The rapid onset of an aneurysm with rupture after a bacterial infection is typical for a mycotic aneurysm.

[Implantable event recorder: a new aid for the diagnosis of arrhythmogenic syncope]. / Implantierbare Ereignisrekorder: ein neues Hilfsmittel in der Diagnostik arrhythmogener Synkopen.

HISTORY AND CLINICAL FINDINGS: A 52-year-old woman had for 31 years been experiencing occasional episodes of dizziness and syncope, as well as sudden attacks of "shaking" in the chest associated with cramp-like pain, nausea and weak spells, each lasting for up to 45 min. She had since childhood been suffering from atopy, with bronchial asthma and polyvalent allergies. On examination, which was otherwise unremarkable, her blood pressure was 140/100 mm Hg with a sinus tachycardia of 110/min. She was admitted for implantation of an event recorder to establish the etiology of the described symptoms. INVESTIGATIONS: The results of routine laboratory tests, including those of thyroid function, were within normal limits. The ECG showed sinus rhythm and minor left precordinal abnormalities of repolarization. The echocardiogram was normal and coronary angiography excluded coronary heart disease. TREATMENT AND COURSE: 3 weeks after ambulatory implantation of an event recorder (Reveal, Medtronic) she again had an attack. The recorded ECG indicated a supraventricular tachycardia (190/min), preceded by an atrial extrasystole, lasting 3 min 14 s. She was treated with digitalis and verapamil, her asthma contraindicating solatol. She had refused further invasive diagnostic measures. The appearance of an allergic rash required a change of drugs to propafenon. But as this, too, was poorly tolerated, electrophysiological testing was undertaken. It revealed an AV nodal reentry tachycardia which was treated with local ablation: supraventricular extrasystoles continued to occur frequently, but there were no further episodes of reentry tachycardia. CONCLUSION: In patients with recurrent syncopes, but otherwise unremarkable clinical findings, an implantable event recorder may provide important diagnostic information, especially relating to a possible arrhythmogenic cause.

[Ventricular pseudoaneurysm in the chronic stage following CABG surgery]. / Ventrikuläres Pseudoaneurysma im chronischen Stadium nach ACVB-Operation.

Two patients with large left ventricular false aneurysms due to CABG-occlusion, myocardial infarction, and ventricular free wall rupture are reported. Colorflow cardiac Doppler showing blood flow at the site of the perforation and in the false aneurysm revealed the diagnosis noninvasively. Because of the high incidence of rupture of false aneurysms, surgical management is essential.