Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Feb 18;14(2):e238499.
doi: 10.1136/bcr-2020-238499.

Cardiac amyloidosis masquerading as acute coronary syndrome

Yong Yong Tew  1   2 , Anne Scott  3   4
Affiliations
Case Reports

Cardiac amyloidosis masquerading as acute coronary syndrome

Yong Yong Tew et al. BMJ Case Rep. .

Abstract

A 53-year-old man presented to a district general hospital with chest pain, ECG changes and a small high-sensitivity cardiac troponin I rise. There were no symptoms of heart failure. CT coronary angiography revealed moderate calcific disease and conventional angiography confirmed no flow limitation. Echocardiography showed left ventricular hypertrophy (LVH). His blood pressure remained normal throughout his admission. The tertiary centre labelled this as a 'plaque rupture' event but the LVH remained unexplained. Cardiac MRI displayed an unusual pattern of late gadolinium enhancement, which was not classical of amyloid. However, a raised serum free kappa light chain along with the deposition of amyloid on his bone marrow aspirate confirmed the diagnosis of primary AL amyloidosis with cardiac involvement. The patient went on to have chemotherapy and remained stable at 1-year follow-up.

Keywords: cardiovascular medicine; haematology (drugs and medicines); radiology.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
ECG showing LVH and widespread T wave inversions. aVR, augmented Vector Right; aVL, augmented Vector Left. aVF, augmented Vector Foot; LVH, left ventricular hypertrophy.
Figure 2
Figure 2
Cardiac MRI displaying LVH but good LV function. LV, left ventricular; LVH, left ventricular hypertrophy.
Figure 3
Figure 3
Still cardiac MRI image showing the late gadolinium contrast pattern that prompted further investigation for cardiac amyloidosis.
See this image and copyright information in PMC

References

    1. Quarta CC, Kruger JL, Falk RH. Cardiac amyloidosis. Circulation 2012;126:e178–82. 10.1161/CIRCULATIONAHA.111.069195 - DOI - PubMed
    1. Bart NK, Thomas L, Korczyk D, et al. Amyloid cardiomyopathy. Heart, Lung and Circulation 2020;29:575–83. 10.1016/j.hlc.2019.11.019 - DOI - PubMed
    1. Rapezzi C, Merlini G, Quarta CC, et al. Systemic cardiac amyloidoses: disease profiles and clinical courses of the 3 main types. Circulation 2009;120:1203–12. 10.1161/CIRCULATIONAHA.108.843334 - DOI - PubMed
    1. John KJ, Mishra AK, Iyyadurai R. A case report of cardiac amyloidosis presenting with chronic pericardial effusion and conduction block. Eur Heart J Case Rep 2019;3:1–7. 10.1093/ehjcr/ytz162 - DOI - PMC - PubMed
    1. Falk RH, Alexander KM, Liao R, et al. AL (Light-chain) cardiac amyloidosis: a review of diagnosis and therapy. J Am Coll Cardiol 2016;68:1323–41. 10.1016/j.jacc.2016.06.053 - DOI - PubMed

Publication types