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== Clinical Summary ==
This 83-year-old male developed chest pain. He had been awakened the previous night with dull chest pain which was retrosternal and radiated through to his back. The pain was associated with sweating, nausea, and vomiting and could not be relieved by antacids. He refused to go to the doctor but the next morning he developed severe epigastric pain and had several episodes of tachycardia (150-160 beats per minute) and later cardiac standstill. He had a history of hypertension and diabetes.
== Images ==
<gallery heights="250px" widths="250px">
File:IPLab4Thrombosis1.jpg|This is a gross photograph of thrombosed coronary artery (arrows).
File:IPLab4Thrombosis2IPLab4Thrombosis2x.jpg|This is a low-power photomicrograph of thrombosed coronary artery. The thrombus (1) completely occludes the vessel. Note the layering of the thrombus. The fibrous cap is ruptured (arrow) and there is hemorrhage into the atherosclerotic plaque. Note the cholesterol crystals in the plaque.
File:IPLab4Thrombosis3.jpg|This is a higher-power photomicrograph of the ruptured fibrous cap (arrows) with hemorrhage (1) into the atherosclerotic plaque.
File:IPLab4Thrombosis4.jpg|This is another high-power photomicrograph of the ruptured fibrous cap (arrows) with hemorrhage (1) into the atherosclerotic plaque. Note the presence of cholesterol crystals.
File:IPLab4Thrombosis10.jpg|This is a high-power photomicrograph of the luminal surface of a re-canalized vessel. Note that the vessel lumen is lined by endothelial cells (arrows).
</gallery>
== Virtual Microscopy ==
<peir-vm>IPLab4Thrombosis</peir-vm>
== Study Questions ==
* <spoiler text="What is the source for the fibroblasts and endothelial cells that are present in organizing thrombi?">Organization of a thrombus involves a process similar to the normal healing response. First there is inflammation with macrophages that phagocytose the thrombotic material. Then fibroblasts and endothelial cells from the vessel wall and the vasa vasorum of the vessel migrate into thrombotic material. This process results in a picture similar to granulation tissue in a healing wound.</spoiler>
* <spoiler text="Does recanalization of a thrombus results in normal blood flow to the tissue?">Usually not. The recanalized lumen is not very large and by the time the thrombus is recanalized, the tissue supplied by that artery is usually already dead. Any blood flow down this vessel will help to accelerate the wound healing process in the tissue downstream.</spoiler>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/1950759-overview eMedicine Medical Library: Noncoronary Atherosclerosis]
* [http://emedicine.medscape.com/article/155919-overview eMedicine Medical Library: Myocardial Infarction]
* [http://www.merckmanuals.com/professional/hematology_and_oncology/thrombotic_disorders/overview_of_thrombotic_disorders.html Merck Manual: Thrombotic Disorders]
* [http://www.merckmanuals.com/professional/cardiovascular_disorders/coronary_artery_disease/acute_coronary_syndromes_acs.html Merck Manual: Acute Coronary Syndromes (ACS)]
=== Journal Articles ===
* Jaeger BR. [http://www.ncbi.nlm.nih.gov/pubmed/11467757 Evidence for maximal treatment of atherosclerosis: drastic reduction of cholesterol and fibrinogen restores vascular homeostasis]. ''Ther Apher'' 2001 Jun;5(3):207-11.
=== Images ===
* [{{SERVER}}/library/index.php?/tags/34-coronary_artery PEIR Digital Library: Coronary Artery Images]
* [http://library.med.utah.edu/WebPath/CVHTML/CVIDX.html WebPath: Cardiovascular Pathology]
== Related IPLab Cases ==
* [[IPLab:Lab 1:Myocardial Infarction|Lab 1: Heart: Myocardial Infarction (Coagulative Necrosis)]]
* [[IPLab:Lab 3:Acute Myocardial Infarction|Lab 3: Heart: Acute Myocardial Infarction]]
* [[IPLab:Lab 3:Healed Myocardial Infarction|Lab 3: Heart: Healed Myocardial Infarction]]
* [[IPLab:Lab 4:Mural Thrombus|Lab 4: Heart: Mural Thrombus]]
* [[IPLab:Lab 4:Pulmonary Congestion and Edema|Lab 4: Lung: Pulmonary Congestion and Edema]]
{{IPLab 4}}
[[Category: IPLab:Lab 4]]