IMR Press / RCM / Volume 22 / Issue 3 / DOI: 10.31083/j.rcm2203094
Open Access Case Report
Cardiac amyloidosis presenting with coronary artery embolization
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1 Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
2 Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
3 Internal Medicine Clinic, Pammakaristos Hospital of Divine Providence, 11144 Athens, Greece
4 First Cardiac Department, Henry Dunant Hospital Center, 11526 Athens, Greece
Academic Editor: Peter A. McCullough
Rev. Cardiovasc. Med. 2021 , 22(3), 883–889; https://doi.org/10.31083/j.rcm2203094
Submitted: 9 March 2021 | Revised: 28 June 2021 | Accepted: 12 July 2021 | Published: 24 September 2021
Abstract

Amyloid light-chain (AL) amyloidosis is a multisystemic disease. Among its clinical manifestations, vein and arterial thromboembolic events are included. We report the unusual case of a 57-year-old female patient with AL amyloidosis presenting with an ST segment elevation myocardial infarction due to coronary artery embolization (CE). The patient reported a history of exertional dyspnoea along with episodes of haemoptysis for the last few months. Her coronary angiography demonstrated embolization of the distal segment of the left anterior descending artery. The main findings of her cardiac ultrasound included concentric left ventricular hypertrophy, mildly impaired left ventricular systolic function, left atrium enlargement and a restrictive-like filling pattern, while her chest computed tomography (CT) demonstrated bilateral pleural effusions. Cardiac magnetic resonance imaging that was performed afterwards, indicated areas of microvascular infarction, a small apex infarct and findings compatible with possible amyloidosis, a diagnosis that was confirmed later by fat tissue biopsy. Patient was referred for an oncology consultation, started therapy with direct oral anticoagulants, angiotensin converting enzyme inhibitor, statins and anti-plasma cell therapy. She has been improving since then and has been free of cardiovascular events for a follow-up period of 12 months. Cardiologists ought to be aware of amyloidosis as a rare but possible cause of coronary embolization, while close collaboration with oncologists is required for the establishment of the correct diagnosis.

Keywords
Cardiomyopathy
Constrictive/restrictive
Coronary blood flow/physiology/microvascular function
Diastolic dysfunction
Cardiac magnetic resonance imaging
Cardio-oncology
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