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Often, it is the question to the medical expert, if there is a causality in the lawful sense from professional effort or psychical stress to acute coronary death or acute myocardial infarction. Following the German social law the connection has to be probably. Probability is well defined juridically opposite to possibility. The medical expert has to answer if the physical or psychical stress has caused the fatality or not more than manifested. Here are discussed arguments that the atheromatosis of the coronary vessels has much more importance than the manifestation of acute death or myocardial infarction caused by spasmus. There is no evidence for the existence of spastic genesis without any arteriosclerotic focus. more...

According to our knowledge to day the cause of a heart infarction is a stenosing atheromatosis of the coronary vessels or an associated coronary thrombosis. Here are described two cases with unusual precipitating factors of a heart infarction, one by an anaphylactic reaction caused by smallpox vaccination, the other case caused by a very intensive stress situation. As the basic condition in the two cases was accepted a coronary heart disease but the described events were considered by the author as the determinating concomitant cause for the social accident insurance in consequence of their intensity and acuteness. more...

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