IPLab:Lab 4:Mural Thrombus
This 67-year-old female was transferred to the hospital from a nursing home in a comatose state. Physical findings on examination were compatible with brain stem infarction. On the fourth hospital day, an electrocardiogram revealed changes compatible with anterior myocardial infarctionMyocardial infarction is necrosis of myocardial tissue which occurs as a result of a deprivation of blood supply, and thus oxygen, to the heart tissue. Blockage of blood supply to the myocardium is caused by occlusion of a coronary artery.. The patient remained comatose with quadriplegia and expired on the 16th hospital day.
Examination of the brain revealed extensive infarction involving the midbrain and cerebellum with complete occlusionAn occlusion is a blockage. of the upper one-half of the basilar artery; there was also extensive coronary artery atherosclerosis. A large aneurysm of the left ventricle was present; this was filled with mural thrombusMural thrombosis is the formation of multiple thrombi along an injured endocardial wall.. Extensive infarction of the lateral and posterior portions of the left ventricular wall toward the base of the heart was also found.
The infarct produced necrosis and inflammation. Also, the infarcted ventricular wall is akinetic and/or dyskinetic (bulges outward during systole). Thus, the blood in the ventricle tends to form thrombi on the surface of the infarcted endocardium.
- Platelets bind to damage endocardium and release ADP, 5-HT, thromboxane and platelet factor 4.
- This results in recruitment of more platelets and more degranulation of platelets with activation of the clotting cascade.
- Thrombin is activated leading to fibrin polymerization.
- This process results in the development of a platelet-fibrin thrombusA thrombus is a solid mass resulting from the aggregation of blood constituents within the vascular system..
The thrombotic material may break off and go to the brain or kidney (the two most likely sites since they get so much blood flow) or any arterial system.
- eMedicine Medical Library: Noncoronary Atherosclerosis
- eMedicine Medical Library: Myocardial Infarction
- Merck Manual: Thrombotic Disorders
- Merck Manual: Acute Coronary Syndromes (ACS)
- Diop D, Aghababian RV. Definition, classification, and pathophysiology of acute coronary ischemic syndromes. Emerg Med Clin North Am 2001 May;19(2):259-67.
- PEIR Digital Library: Mural Thrombus Images
- WebPath: Myocardial Infarction
- WebPath: Atherosclerotic Cardiovascular Disease
Related IPLab Cases
- Lab 1: Heart: Myocardial Infarction (Coagulative Necrosis)
- Lab 3: Heart: Acute Myocardial Infarction
- Lab 3: Heart: Healed Myocardial Infarction
- Lab 4: Coronary Artery: Thrombosis
- Lab 4: Lung: Pulmonary Congestion and Edema