The present case is that of a 62-year-old man suffering from central thoracic pain, tingling sensation in the hands and nausea. A week earlier he had had a similar episode without requiring medical assistance. Forty-five minutes after the onset of symptoms, he was attended at the local hospital, diagnosed as having an inferior infarction, and started fibrinolysis with Streptokinase 1,500,000 IU. He was also treated with Solinitrin, Aspirin and Zantac, and was subsequently referred to the Regional Hospital as there were no beds available in the Coronary Unit.
Half an hour after admission to the Hospital Comarcal (around 4.30 hours after the onset of symptoms), he began to experience pain in both lower limbs, accompanied by intense pallor and no pulse. Computerised Axial Tomography (CAT) was performed, which ruled out aortic dissection and, suspecting embolism, he was referred to the Provincial Hospital.
At the referral centre, a CT scan of the chest showed no pathology in the thoracic aorta and an ultrasound scan of the lower limbs showed bilateral occlusion at the popliteal level. He underwent surgery and bilateral embolectomy, recovering the colour, but the coldness persisted. The histopathological study showed fibrohaematic thrombotic material.
After the first few hours the patient showed haemodynamic instability, with the appearance of lividity in the lower limbs, renal failure and shock, with death finally occurring 24 hours after the onset of symptoms.
The external examination of the corpse revealed a purplish-red colouring in the lower third of the thighs, knees, genital area and lower abdomen.
The lungs were increased in size and consistency, crepitus was perceived on pressure, the fingerprint remained after pressure (fovea) and when cut, after compression, foam spurted out. The right lung weighed 850 grams and the left lung weighed 640 grams.
After incising the pericardial sac, a slight cardiomegaly weighing 390 grams was observed. The left ventricle was hypertrophic with a maximum free wall thickness of 2 cm. Histopathological analysis of the heart showed chronic ischaemic heart disease, with an old infarct and a recent infarct, 1-3 weeks old, on the posterior aspect of the left ventricle.
The thoracic aorta has a large ruptured atherosclerotic plaque with intraplaque haemorrhage and thrombotic material adhering below the arch. The endothelium of the abdominal aorta is occupied by reddish coagulated haematic material. The liver exhibited a steatotic appearance. Examination of the liver and lung confirms the macroscopic diagnoses of steatosis and pulmonary oedema.

In the arterioles supplying the skeletal muscles of the legs, there were numerous emboli from ruptured atheroma plaques causing ischaemic necrosis of the muscle fibres.

Histologically, the kidneys show acute tubular necrosis, myoglobin pigment in tubules and emboli in arterioles from ruptured atheroma plaques.