Abstract
A 32 year old man presenting with typical angina pectoris was found to have primary cardiac amyloidosis. Myocardial infiltration was strongly suggested by echocardiography, and a histological diagnosis was confirmed by renal biopsy. Nevertheless, technetium pyrophosphate myocardial scanning, recently proposed as a sensitive non-invasive test, showed negative results despite widespread cardiac involvement confirmed at necropsy after unexpected sudden death. Postmortem findings also showed subintimal amyloid material in a severely narrowed right coronary artery. This case highlights several unusual clinical features in a patient with advanced primary cardiac amyloidosis.
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- Bhandari A. K., Nanda N. C. Myocardial texture characterization by two-dimensional echocardiography. Am J Cardiol. 1983 Mar 1;51(5):817–825. doi: 10.1016/s0002-9149(83)80139-8. [DOI] [PubMed] [Google Scholar]
- Buja L. M., Khoi N. B., Roberts W. C. Clinically significant cardiac amyloidosis. Clinicopathologic findings in 15 patients. Am J Cardiol. 1970 Oct;26(4):394–405. doi: 10.1016/0002-9149(70)90736-8. [DOI] [PubMed] [Google Scholar]
- Falk R. H., Lee V. W., Rubinow A., Hood W. B., Jr, Cohen A. S. Sensitivity of technetium-99m-pyrophosphate scintigraphy in diagnosing cardiac amyloidosis. Am J Cardiol. 1983 Mar 1;51(5):826–830. doi: 10.1016/s0002-9149(83)80140-4. [DOI] [PubMed] [Google Scholar]
- Hake H., Goll U., Thoenes W. Primary perireticulin amyloidosis in a 14-year-old girl. Eur J Pediatr. 1976 Dec 9;124(1):43–49. doi: 10.1007/BF00452413. [DOI] [PubMed] [Google Scholar]
- Kyle R. A. Amyloidosis. Clin Haematol. 1982 Feb;11(1):151–180. [PubMed] [Google Scholar]
- Kyle R. A., Bayrd E. D. Amyloidosis: review of 236 cases. Medicine (Baltimore) 1975 Jul;54(4):271–299. doi: 10.1097/00005792-197507000-00001. [DOI] [PubMed] [Google Scholar]
- Pick A. I., Versano I., Schreibman S., Ben-Bassat M., Shoenfeld Y. Agammaglobulinemia, plasma cell dyscrasia, and amyloidosis in a 12-year-old child. Am J Dis Child. 1977 Jun;131(6):682–686. doi: 10.1001/archpedi.1977.02120190076017. [DOI] [PubMed] [Google Scholar]
- Roberts W. C., Waller B. F. Cardiac amyloidosis causing cardiac dysfunction: analysis of 54 necropsy patients. Am J Cardiol. 1983 Jul;52(1):137–146. doi: 10.1016/0002-9149(83)90084-x. [DOI] [PubMed] [Google Scholar]
- Schiff S., Bateman T., Moffatt R., Davidson R., Berman D. Diagnostic considerations in cardiomyopathy: unique scintigraphic pattern of diffuse biventricular technetium-99m-pyrophosphate uptake in amyloid heart disease. Am Heart J. 1982 Apr;103(4 Pt 1):562–563. doi: 10.1016/0002-8703(82)90343-x. [DOI] [PubMed] [Google Scholar]
- Siqueira-Filho A. G., Cunha C. L., Tajik A. J., Seward J. B., Schattenberg T. T., Giuliani E. R. M-mode and two-dimensional echocardiographic features in cardiac amyloidosis. Circulation. 1981 Jan;63(1):188–196. doi: 10.1161/01.cir.63.1.188. [DOI] [PubMed] [Google Scholar]
- Smith R. R., Hutchins G. M. Ischemic heart disease secondary to amyloidosis of intramyocardial arteries. Am J Cardiol. 1979 Sep;44(3):413–417. doi: 10.1016/0002-9149(79)90389-8. [DOI] [PubMed] [Google Scholar]
- Sobol S. M., Brown J. M., Bunker S. R., Patel J., Lull R. J. Noninvasive diagnosis of cardiac amyloidosis by technetium-99m-pyrophosphate myocardial scintigraphy. Am Heart J. 1982 Apr;103(4 Pt 1):563–566. doi: 10.1016/0002-8703(82)90344-1. [DOI] [PubMed] [Google Scholar]
- St John Sutton M. G., Reichek N., Kastor J. A., Giuliani E. R. Computerized M-mode echocardiographic analysis of left ventricular dysfunction in cardiac amyloid. Circulation. 1982 Oct;66(4):790–799. doi: 10.1161/01.cir.66.4.790. [DOI] [PubMed] [Google Scholar]
- Swanton R. H., Brooksby I. A., Davies M. J., Coltart D. J., Jenkins B. S., Webb-Peploe M. M. Systolic and diastolic ventricular function in cardiac amyloidosis. Studies in six cases diagnosed with endomyocardial biopsy. Am J Cardiol. 1977 May 4;39(5):658–664. doi: 10.1016/s0002-9149(77)80125-2. [DOI] [PubMed] [Google Scholar]
- Wizenberg T. A., Muz J., Sohn Y. H., Samlowski W., Weissler A. M. Value of positive myocardial technetium-99m-pyrophosphate scintigraphy in the noninvasive diagnosis of cardiac amyloidosis. Am Heart J. 1982 Apr;103(4 Pt 1):468–473. doi: 10.1016/0002-8703(82)90331-3. [DOI] [PubMed] [Google Scholar]
- Wright J. R., Calkins E. Clinical-pathologic differentiation of common amyloid syndromes. Medicine (Baltimore) 1981 Nov;60(6):429–448. doi: 10.1097/00005792-198111000-00004. [DOI] [PubMed] [Google Scholar]

