PMC9979804_01
12-lead electrocardiogram on admission.
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F1
Electrocardiogram (ECG) on admission demonstrated sinus rhythm, PR interval 182 ms, normal QRS complex voltages and QRS duration 112 ms [Figure 1].
(a) Transthoracic echocardiogram, parasternal long axis view. (b) Transthoracic echocardiogram, apical 4 chamber view, focused view of the left ventricle. (c) Transthoracic echocardiogram with speckle tracking, longitudinal strain map.
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F2
Transthoracic echocardiography (TTE) demonstrated a marked symmetrical increase in left ventricular wall thickness on the parasternal long axis [Figure 2a] and apical 4-chamber view [Figure 2b], with a small pericardial effusion. Strain imaging on TTE showed impaired global longitudinal strain (GLS) of -11.5% predominantly affecting the basal and mid-ventricular myocardial segments, with sparing of the apical segments ('cherry on top' pattern) [Figure 2c].
Histology specimen from endomyocardial biopsy. (a) Photomicrograph shows myocardium with extracellular accumulation of hyalinised material (arrow) in between cardiomyocytes (H&E stain, x200). (b) Photomicrograph shows extracellular material that is immunoreactive for amyloid P protein (arrow) (immunoperoxidase, x200).
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F3
Histology images showed staining of the myocardium with haematoxylin and eosin (H&E) [Figure 3a] and immunoperoxidase [Figure 3b].
PMC9979804_02