Cardiac Amyloidosis: A Case Report

Abstract

In this report, we present a clinical case of a 63-year-old female patient with chronic heart failure (CHF) due to cardiomyopathy of unknown origin whose rectal biopsy revealed amyloid deposits 3 months before hospitalization. Some diagnostic tests were performed to determine the cause of cardiomyopathy. According to echocardiography, left heart chambers were dilated, local contractility of the left ventricular myocardium was impaired and its concentric hypertrophy has occurred. Cardiac magnetic resonance imaging revealed signs of restrictive cardiomyopathy, which were manifested by impaired local contractility of the ventricles and their systolic dysfunction without dilatation of the heart chambers. A contrast-enhanced study revealed spread subendocardial, subepicardial and focal intramural late gadolinium enhancement in the walls of the heart chambers and atrioventricular valves. Bilateral hydrothorax and pericardial effusion were diagnosed. The bone marrow biopsy revealed the presence of 2.5% clonal plasma cells. A genetic blood testing did not find genetic change known to cause hereditary transthyretin amyloidosis (ATTR amyloidosis). Levels of cardiac biomarkers troponin and NPproBNP were 181 ng/L and 6689 ng/ml, respectively.