Diagnostic work-up of cardiac amyloidosis.

摘要

A 75-year-old man who presented with signs of heart failure was referred for further evaluation of hypertrophic cardiomyopathy. ECG showed a pseudo-infarct pattern (figure A), troponins were slightly elevated and NT-pro BNP was markedly raised. Echo-cardiography demonstrated a thickened myocardium with speckled appearance, surrounded by a mild to moderate amount of pericardial fluid (figure B). Systolic function was preserved, while diastolic function was impaired with signs of elevated left ventricular end-diastolic pressure (figures C and D). Cardiac MRI showed biventricular hypertrophy (figures E and F) with diffuse delayed gadolinium enhancement of both ventricles, most pronounced in the subendocardium (figure E), consistent with cardiac amyloidosis.