Truth will out: a rare case of amyloid cardiomyopathy

Description

A 65-year-old patient with no medical history of notice was referred to our cardiology outpatient clinic for the evaluation of exertional dyspnoea. After a thorough work-up, the suspicion of an amyloid cardiomyopathy was raised by the cardiac magnetic resonance (CMR) findings (figure 1A–C), but laboratory tests, abdominal fat pad and bone marrow biopsies failed to prove the diagnosis. Eventually endomyocardial biopsies confirmed the diagnosis of secondary (AA) amyloidosis. Furthermore, the CMR scout images unveiled a large abdominal mass (figure 1D), with subsequent CT being suggestive of a pancreatic neuroendocrine tumour with multiple hepatic metastases.

Figure 1

Cardiac magnetic resonance images showing diffuse subendocardial late gadolinium enhancement of the left ventricle, right ventricle and atria. (A) Four-chamber image; (B) two-chamber image; (C) midventricular, short-axis image and (D) balanced steady-state free precession (SSFP) scout image showing a large abdominal mass.

Clinically apparent heart disease...

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