PMC9356901_01
ECG showed sinus rhythm with low voltage in the limb leads.
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fig1
Twelve lead electrocardiogram (ECG) showed sinus tachycardia with low voltage in the limb leads (Figure 1).
Echocardiographic polar map highlighted a decrease in global longitudinal strain.
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fig2
Echocardiogram revealed left ventricular (LV) ejection fraction of 65%, severely increased LV posterior wall end diastolic thickness (17 mm) (normal: 6 to 9 mm), grade II diastolic dysfunction, mildly enlarged right ventricular (RV) chamber with mildly reduced systolic function, RV systolic pressure of 56 mmHg, and reduced peak average global longitudinal strain with apical sparing of the LV on strain imaging and polar map (Figure 2).
CMR revealed patchy midmyocardial and subendocardial LGE.
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fig3
Cardiac magnetic resonance (CMR) showed thick myocardial walls with patchy subendocardial late gadolinium enhancement (LGE) prominent along the lateral, inferoseptal walls from the base through the midventricle and papillary muscles (Figure 3).
Right PYP scan showed increased PYP uptake compared to the left PYP scan done almost a year earlier.
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fig4
A pyrophosphate (PYP) cardiac scan compared to a year earlier was positive for scintigraphic evidence of evolving amyloid deposition (Figure 4).