PMC9949727_01
Electrocardiogram showed atrial fibrillation, left axis deviation and low voltage QRS.
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Electrocardiogram (ECG) indicated new atrial fibrillation and low voltage QRS (Fig. 1).
Echocardiogram indicated significant left ventricular hypertrophy, mildly thickened mitral and tricuspid valve leaflets, and small pericardial effusion.
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An echocardiography was obtained and showed significant left ventricular hypertrophy (LVH) (Fig. 2) and global hypokinesis with left ventricular ejection fraction of 35%.
Cardiac magnetic resonance demonstrated (A) Cine images with left ventricular hypertrophy; (B) Late gadolinium enhancement with diffuse gadolinium enhancement of myocardium; (C) Phase sensitive inversion recovery showed diffuse myocardial gadolinium enhancement.
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A cardiac magnetic resonance imaging was obtained given continued suspicion of cardiac amyloidosis (CA) despite negative bone marrow and abdominal fat pad biopsy, and it demonstrated diffuse subendocardial enhancement with areas of mid-myocardial enhancement (Fig. 3), which was consistent with CA.
Endomyocardial biopsy A. Congo red staining showed amyloid deposits (red arrow); B. Amyloids deposits in fluorescent green (green arrow).
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Hematoxylin and eosin staining of endomyocardial biopsy samples showed Congo red-positive amyloid deposits (Fig. 4).