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Circulation, Vol 71, 699-708, Copyright © 1985 by American Heart Association
E Falk
Extensive microscopic examination of epicardial arteries and myocardium was
performed in 25 cases of sudden death due to acute coronary thrombosis.
Eighty-one percent of the thrombi had a layered structure with thrombus
material of differing age, indicating that they were formed successively by
repeated mural deposits that caused progressive luminal narrowing over an
extended period of time. This episodic growth of the thrombus was
accompanied by intermittent fragmentation of thrombus in 73% of the cases,
with peripheral embolization causing microembolic occlusion of small
intramyocardial arteries associated with microinfarcts. The period of
unstable angina before the final heart attack was, in all but one of 15
patients, characterized by such an ongoing thrombotic process in a major
coronary artery where recurrent mural thrombus formation seemed to have
alternated with intermittent thrombus fragmentation. The culmination of
this "dynamic" thrombotic process in total vascular occlusion caused the
final infarction and/or sudden death.
ARTICLES
Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death. Autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion
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