Amyloid cardiomyopathy: a hidden heart failure cause that is often misdiagnosed

Abstract

Background: Congestive heart failure (CHF) is a very common condition, especially in the elderly, characterized by dyspnea, orthopnea, nocturnal paroxysmal dyspnea, and peripheral edema.

Clinical presentation and intervention: We report the case of a 76-year-old with CHF symptoms for the last 3 months. The ECG and transthoracic echocardiogram were suggestive of CHF due to amyloid cardiomyopathy. After cardiac MRI, a positive Congo red staining of subcutaneous fat aspiration and a negative genetic testing for mutant transthyretin, senile amyloid cardiomyopathy (ATTRw) was expected.

Conclusion: Cardiac amyloidosis is remarkably underdiagnosed. Mostly, the treatment is supportive and differs from other typical causes of CHF, and thus, a high index of suspicion is required.

Keywords:

• Congestive heart failure
• cardiomyopathy
• amyloidosis
• transthyretin
• monoclonal immunoglobulin light chain