A hypertrophic senile heart

摘要

In this case report we describe a 77-year-old man with a history of bilateral carpal tunnel syndrome who presented with dyspnoea on exertion. The electrocardiogram showed low voltage QRS complexes, while echocardiography demonstrated prominent concentric hypertrophy of the left ventricle with speckled appearance of the myocardium (Fig. 1a). Coronary angiography revealed severe proximal left anterior descending artery stenosis for which intervention was performed. Since symptoms persisted, cardiac magnetic resonance imaging was performed for further evaluation (Fig. 1b, c). The proper late gadolinium enhancement (LGE) images were difficult to obtain due to the inability to suppress the signal of ‘normal’ myocardium—a pathognomonic phenomenon for diffuse amyloid fibrils deposition in the whole myocardium (Fig. 1d, e). Endomyocardial biopsy verified the diagnosis of transthyretin cardiac amyloidosis (ATTR-CA) with Congo red staining of transthyretin fibrils (Fig. 1f).