Cor Vasa 2010, 52(3):188-192 | DOI: 10.33678/cor.2010.047

Amyloidosis as a rare cause of dyspnea

Eva Kociánová^1,*, Jan Václavík¹, Miloš Táborský¹, Marián Fedorco¹, Pavel Folwarczny¹, Tomáš Pika², Yvona Hrčková¹

¹ I. interní klinika

² III. interní klinika Fakultní nemocnice Olomouc a Lékařské fakulty Univerzity Palackého v Olomouci, Česká republika

We report the case of a 44-year-old man examined for dyspnea lasting several months with manifestations of heart failure. The patient developed the dyspnea after a protracted febrile condition. An electrocardiogram showing a scar on the anterior wall and left ventricular dysfunction with a 40% left ventricular ejection fraction (LVEF) and mild pericardial exudates led initially to suspected coronary heart disease ruled out by a negative coronary angiogram. Marked left ventricular hypertrophy on follow-up echocardiography and the finding of nephritic proteinuria made us consider a systemic disease. Heart magnetic resonance imaging excluded previous myocarditis and late subendocardial enhancement together with the detection of serum and urinary paraprotein, and a non-proportional increase in lambda free light chains, established the diagnosis of primary amyloidosis (AL) confirmed by biopsy. There was regression of signs of left-heart failure following titration of doses of a beta-blocker, ACE inhibitor and diuretics. The patient has been scheduled for chemotherapy in the ensuing months.

Keywords: Amyloidosis; Cardiomyopathy; Hypertrophy; Heart Failure

Published: March 1, 2010  Show citation