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. 1999 Dec 7;131(11):838-41.
doi: 10.7326/0003-4819-131-11-199912070-00007.

Systemic amyloidosis presenting with angina pectoris

J Al Suwaidi  1 , J L Velianou, M A Gertz, R O Cannon 3rd, S T Higano, D R Holmes Jr, A Lerman
Affiliations

Systemic amyloidosis presenting with angina pectoris

J Al Suwaidi et al. Ann Intern Med. .

Abstract

Background: Manifestations of cardiac amyloidosis may include congestive heart failure and sudden cardiac death. Although vascular involvement in patients with amyloidosis is common, systemic amyloidosis presenting with angina is rare.

Objectives: To report on patients with systemic amyloidosis presenting with angina pectoris.

Design: Case series.

Setting: Academic medical center.

Patients: Five patients who presented with angina pectoris and normal coronary angiogram as the initial manifestation of systemic amyloidosis.

Measurements: Endothelial-dependent and endothelial-independent coronary flow reserve.

Results: All patients had coronary flow reserve abnormalities and subsequently developed congestive heart failure and systemic manifestations of amyloidosis. Histologic evaluation revealed amyloid deposition in the intramyocardial coronary vessels.

Conclusions: Cardiac amyloidosis can present as angina pectoris associated with coronary flow reserve abnormalities despite normal coronary angiograms. This finding may have major therapeutic and prognostic implications in this patient population.

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