SESSION TITLE: Rare Disease Case Report Posters
SESSION TYPE: Case Report Poster
PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM
INTRODUCTION: Amyloid Cardiomyopathy is characterized by bi-ventricular thickening due to amyloid deposition leading to diastolic dysfunction.
CASE PRESENTATION: A 73 year old female with no past medical history presented to our emergency department (ED) with gradually worsening shortness of breath for few weeks. She denied any associated complaints of chest pain, palpitations or dizziness. On physical exam, the patient had bilateral rales at the lung bases. The electrocardiogram showed low voltage complexes with right bundle branch block and left anterior fascicular block. The laboratory work came back significant for an elevated BNP (1450 pg/ml) with a normal complete blood count, serum chemistry and negative cardiac biomarkers. The patient was treated with intravenous diuretics in the ED and admitted to a telemetry floor. The echocardiogram performed on admission revealed concentric bi-ventricular hypertrophy resulting in a restrictive pattern and highly echogenic myocardium with ‘sparkling appearance’, suggestive of Cardiac Amyloidosis. The LV systolic function was moderately decreased with global hypokinesis and there was bilateral atrial enlargement along with thickening of valve leaflets and inter-atrial septum. A Cardiac MRI also showed delayed nodular enhancement of the myocardium indicative of an infiltrative cardiomyopathy such as Amyloid. Patient underwent an abdominal wall fat pad biopsy which came positive for light-chain Amyloidosis.
DISCUSSION: Amyloid Cardiomyopathy most commonly presents with heart failure, conduction abnormalities or exertional syncope due to inability to augment cardiac output. The combination of increased ventricular mass on echocardiogram and reduced electrocardiographic voltages, along with granular appearance of the myocardium is highly suggestive of Amyloid Cardiomyopathy. The diagnosis can be confirmed by demonstrating amyloid deposits on histologic examination of tissues from abdominal fat pad or kidney in patients with appropriate cardiac findings.
CONCLUSIONS: Cardiac amyloidosis should be considered in any adult with unexplained heart failure and an echocardiogram showing increased wall thickness with a nondilated left ventricular cavity, particularly when associated with low voltage on electrocardiogram.
Reference #1: N/A
DISCLOSURE: The following authors have nothing to disclose: Sameer Chadha, On Chen, Sunday Olatunde, Adnan Sadiq, Gerald Hollander, Jacob Shani
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