Hypertrophic cardiomyopathy unveiling multiple myeloma: A diagnostic challenge

Abstract

Hypertrophic cardiomyopathy can be a rare initial presentation of hematologic malignancies such as multiple myeloma that is caused by an uncontrolled clonal proliferation of plasma cells. We report a case of a 65-year-old man, presenting with congestive heart failure, in whom EKJ and echocardiography findings are suggestive of cardiac amyloidosis, and which the etiological assessment identified multiple myeloma as the underlying cause. Through this case, we demonstrate that cardiac amyloidosis secondary to multiple myeloma can present as a newly diagnosed and rapidly progressive heart failure before any typical clinical features of multiple myeloma appear.

Keywords: Cardiac amyloidosis; Hypertrophic cardiomyopathy; Multiple myeloma, Heart failure.

Fig. 1

EKJ showing first-degree atrioventricular block, a QS pattern in V1 to V4, and low voltage in precordial leads.

Fig. 2

A 48 hours EKG showing first degree atrioventricular block.

Fig. 3

Echocardiography showing both thickened ventricular myocardium with granular sparkling, and thickened atrial septum, along with pericardial effusion.

Fig. 4

Alteration of global longitudinal strain in patient with cardiac amyloidosis associated with multiple myeloma.

Fig. 5

Patient's chest X-ray showing cardiomegaly with Blunting of the pleural recesses with bilateral alveolo-interstitial syndrome.

Fig. 6

Protein electrophoresis of the patient.