Abstract
A 79‐year‐old patient repeatedly presented with chest discomfort and dyspnea on exertion. With echocardiography a prominent left ventricular and septal hypertrophy was detected with reduced left ventricular function. Despite successful revascularization and excellent results after stenting, the patient showed persistently elevated troponin levels. To investigate the abnormal findings of persistent troponin elevation, septal hypertrophy, and heart failure we performed endomyocardial biopsies which showed widespread myocardial amyloidosis. Amyloid subtyping revealed transthyretin amyloidosis. This is the first case showing persistent troponin elevation in a patient with tranthyretin amyloidosis. Very few other cases have been published on the topic of cardiac amyloidosis and troponin elevation so far. Our case serves as an illustrating example in the differential diagnosis of nonischemic causes of persistent troponin elevation. It is important to consider cardiac amyloidosis in patients with troponin elevation and heart failure since the clinical management differs significantly from other causes of heart failure. Copyright © 2009 Wiley Periodicals, Inc.
Keywords: cardiac amyloidosis, troponin, heart failure, syncope
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References
- 1. Klein AL, Hatle LK, Burstow DJ, Taliercio CP, Seward JB et al.: Comprehensive Doppler assessment of right ventricular diastolic function in cardiac amyloidosis. J Am Coll Cardiol 1990; 15: 99–108. [DOI] [PubMed] [Google Scholar]
- 2. Falk RH: Diagnosis and management of the cardiac amyloidoses. Circulation 2005; 112: 2047–2060. [DOI] [PubMed] [Google Scholar]
- 3. Cornwell GG III, Westermark P: Senile amyloidosis: A protean manifestation of the aging process. J Clin Pathol 1980; 33: 1146–1152. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Freda BJ, Tang WH, Van Lente F, Peacock WF, Francis GS: Cardiac troponins and renal insufficiency: review and clinical implications. J Am Coll Cardiol 2002; 40: 2065–2071. [DOI] [PubMed] [Google Scholar]
- 5. Ellis K, Dreisbach AW, Lertora JJL: Plasma elimination of cardiac troponin I in end‐stage renal disease. South Med J 2001; 94: 993–996. [PubMed] [Google Scholar]
- 6. Chamarthi B, Dubrey SW, Cha K, Skinner M, Falk RH: Features and prognosis of exertional syncope in light‐chain associated AL cardiac amyloidosis. Am J Cardiol 1997; 80: 1242–1245. [DOI] [PubMed] [Google Scholar]
- 7. Mueller PS, Edwards WD, Gertz MA: Symptomatic ischemic heart disease resulting from obstructive intramural coronary amyloidosis. Am J Med 2000; 109: 181–188. [DOI] [PubMed] [Google Scholar]
- 8. Al Suwaidi J, Velianou JL, Gertz MA, Cannon RO III, Higano ST et al.: Systemic amyloidosis presenting with angina pectoris. Ann Intern Med 1999; 131: 838–841. [DOI] [PubMed] [Google Scholar]