Iranian Heart Association Iranian Heart Journal 25 3 2024 07 01 Multiple Myeloma Presenting as Cardiac Amyloidosis With Biventricular Failure: A Case Report 72 79 199187 EN Ajinkya Rahatgaonkar Department of Medicine and 2 Department of Pathology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India. Prativa Sethi Department of Medicine and 2 Department of Pathology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India. Prasan Kumar Panda Department of Medicine and 2 Department of Pathology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India. Shalini Singh Department of Medicine and 2 Department of Pathology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India. Journal Article 2024 01 20 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. <strong><em>(Iranian Heart Journal 2024; 25(3): 72-79)</em></strong> https://journal.iha.org.ir/article_199187_68e7cc503bc1c61f792971f695a2b972.pdf