Atheroma or Thrombus in Sudden Cardiac Death?

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The discussion centers on a case of sudden cardiac death in a 56-year-old man with critical stenosis in the left anterior descending artery, leading to a question about the most likely pathological feature. Initially, the poster considers thrombus as the answer due to its association with acute coronary syndrome. However, further analysis reveals that the presence of a lipid core and fibrous cap indicates an atheroma, suggesting that the thrombus likely formed from a ruptured atheroma rather than being the primary pathological feature. The consensus shifts towards atheroma as the correct answer, emphasizing the importance of histopathological characteristics in determining the cause of death. Understanding the relationship between atheroma and thrombus is crucial in cardiac pathology.
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hi all,
im new here. this may be a silly question, but I am going through exam quetions (MCQs) and wondered if you could help me with this one.

A 56 yr old man with a history of angina dies suddenly. An autopsy reveals critical stenosis in the left anterior descending artery. The lesion has a lipid core with a fibrous calf. What is the most likely pathological feature?

A - thrombus
B - atheroma
C - embolus
D - carcinoma in situ
D - infective embolus

I think the answer is A (thrombus), because the thrombus seems to be the cause of this man's death (acute coronary syndrome). I'm thrown off by the words "pathological feature" - it makes me consider anser B (atheroma) because an atheroma would initiallyhave to be present, then rupture to form the thrombus.

Please comment on why you think I am wrong/right.

Thank you!
 
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missy75 said:
I'm thrown off by the words "pathological feature" - it makes me consider anser B (atheroma) because an atheroma would initiallyhave to be present, then rupture to form the thrombus.

Please comment on why you think I am wrong/right.

Thank you!

Why do you think it's a thrombus? What would you expect in a 'tissue' prep of a thrombus? What about an atheroma? In fact, a fatal event would likely be due to a combination of both, with a thrombus closing a lumen already partially blocked by an atheroma. What does the histopathology describe? I think that's what the question is asking.
 
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thanks, I've changed my answer to atheroma now. The lipid core and fibrous calf hints at this, and there is no mention of a blood clot/evidence of rupture of the plaque.
 

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