65 year old man with hypertension was admitted for acute onset of crushing chest pain and breathlessness. He died a few days later.
The anteromedial aspect of the hypertrophied left ventricle shows coagulative necrosis (infarction) and thinning of the myocardium. There is accompanying darkish haemorrhage. Note the pale brownish mural thrombus loosely adherent to the roughened endocardium at 4-5 o’clock.