Department of Medicine and 2 Department of Pathology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India.
Abstract
Cardiomyopathies related to amyloidosis are recognized as a type of infiltrative disorder; however, the degree of infiltration does not align with the severity of hemodynamic impairment. We present a case involving an elderly woman without any known comorbidities or substance use history who presented with congestive heart failure at our hospital. She had been treated with long-term diuretic therapy for heart failure by various physicians. A strong suspicion of primary cardiomyopathy was maintained given the absence of prior comorbidity after a comprehensive medical history review and examination. Two-dimensional echocardiography, protein electrophoresis, and bone marrow examination collectively revealed cardiac amyloidosis secondary to plasma cell dyscrasia. Standard heart failure treatment was initiated alongside chemotherapy; nonetheless, the patient experienced sudden cardiac death at home during follow-up. This case underscores the importance of early diagnosis and treatment of heart failure for patients with cardiac amyloidosis, and it also brings attention to the fact that cardiac amyloidosis can be the first sign of multiple myeloma. (Iranian Heart Journal 2024; 25(3): 72-79)
Merlini G, Palladini G. Differential diagnosis of monoclonal gammopathy of undetermined significance. Vol. 2012, Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program. 2012.
Kyle RA, Linos A, Beard CM, Linke RP, Gertz MA, Michael O’fallon W, et al. Incidence and Natural History of Primary Systemic Amyloidosis in Olmsted County. 1950.
Rapezzi C, Merlini G, Quarta CC, Riva L, Longhi S, Leone O, et al. Systemic cardiac amyloidoses: Disease profiles and clinical courses of the 3 main types. Circulation. 2009 Sep; 120(13):1203–12.
Grogan M, DIspenzieri A, Gertz MA. Light-chain cardiac amyloidosis: Strategies to promote early diagnosis and cardiac response. Vol. 103, Heart. BMJ Publishing Group; 2017. p. 1065–72.
Pellikka PA. Endomyocardial biopsy in 30 patients with primary amyloidosis and suspected cardiac involvement. Arch Intern Med. 1988; 148(3).
Arbustini E, Merlini G, Gavazzi A, Grasso M, Diegoli M, Fasani R, et al. Cardiac immunocyte-derived (AL) amyloidosis: An endomyocardial biopsy study in 11 patients. Am Heart J. 1995; 130(3 PART 1).
Ilias Basha H, Raj E, Bachuwa G. Cardiac amyloidosis masquerading as biventricular hypertrophy in a patient with multiple myeloma. Available from: http://casereports.bmj.com/
Bokhari S, Castaño A, Pozniakoff T, Deslisle S, Latif F, Maurer MS. 99mTc-pyrophosphate scintigraphy for differentiating light-chain cardiac amyloidosis from the transthyretin-related familial and senile cardiac amyloidoses. Circ Cardiovasc Imaging. 2013; 6(2).
Traynor AE, Gertz MA, Kyle RA. Cranial neuropathy associated with primary amyloidosis. Ann Neurol. 1991; 29(4).
Martins AM, Ferreira FS, Leite IM, Fonseca M, Victorino R. Facial Paralysis as Initial Manifestation of Light-chain Amyloidosis. Cureus. 2019 Aug 29;
Sanchorawala V, Wright DG, Seldin DC, Falk RH, Berk JL, Dember LM, et al. Low-dose continuous oral melphalan for the treatment of primary systemic (AL) amyloidosis. Br J Haematol. 2002; 117(4).
Wechalekar AD, Goodman HJB, Lachmann HJ, Offer M, Hawkins PN, Gillmore JD. Safety and efficacy of risk-adapted cyclophosphamide, thalidomide, and dexamethasone in systemic AL amyloidosis. Blood. 2007; 109(2).
Rahatgaonkar,A. , Sethi,P. , Panda,P. Kumar and Singh,S. (2024). Multiple Myeloma Presenting as Cardiac Amyloidosis With Biventricular Failure: A Case Report. Iranian Heart Journal, 25(3), 72-79.
MLA
Rahatgaonkar,A. , , Sethi,P. , , Panda,P. Kumar, and Singh,S. . "Multiple Myeloma Presenting as Cardiac Amyloidosis With Biventricular Failure: A Case Report", Iranian Heart Journal, 25, 3, 2024, 72-79.
HARVARD
Rahatgaonkar A., Sethi P., Panda P. Kumar, Singh S. (2024). 'Multiple Myeloma Presenting as Cardiac Amyloidosis With Biventricular Failure: A Case Report', Iranian Heart Journal, 25(3), pp. 72-79.
CHICAGO
A. Rahatgaonkar, P. Sethi, P. Kumar Panda and S. Singh, "Multiple Myeloma Presenting as Cardiac Amyloidosis With Biventricular Failure: A Case Report," Iranian Heart Journal, 25 3 (2024): 72-79,
VANCOUVER
Rahatgaonkar A., Sethi P., Panda P. Kumar, Singh S. Multiple Myeloma Presenting as Cardiac Amyloidosis With Biventricular Failure: A Case Report. Iranian Heart Journal, 2024; 25(3): 72-79.
