PMC8526272_01
Previous echocardiogram (a). Parasternal long axis (b). Parasternal short axis (c). Apical four-chamber showing moderate concentric left ventricular hypertrophy, right ventricular dilation, and moderately dilated atria.
CRIC2021-5673364.001.jpg
PMC8526272_01_CRIC2021-5673364.001.jpg
fig1
Previous echocardiograms (Figure 1) had shown moderate concentric left ventricular hypertrophy, normal ejection fraction, hypokinesis of basoseptal left ventricular wall, with right ventricular dilation, moderately dilated atria, and pulmonary hypertension at around 40 mmHg; tissue Doppler was not performed.
Echocardiogram (a). Parasternal long axis (b). Parasternal short axis (c). Apical two-chamber of left ventricle and (d) tissue Doppler showing severe left ventricular hypertrophy and diastolic dysfunction.
CRIC2021-5673364.002.jpg
PMC8526272_01_CRIC2021-5673364.002.jpg
fig2
Echocardiographic strain analysis showing a relative sparing of the apex compared to the bases.
CRIC2021-5673364.003.jpg
PMC8526272_01_CRIC2021-5673364.003.jpg
fig3
Cardiac magnetic resonance; (a) left ventricle hypertrophy, (b) abnormal nulling of the myocardium.
CRIC2021-5673364.004.jpg
PMC8526272_01_CRIC2021-5673364.004.jpg
fig4
Cardiac biopsy with Congo red stain, demonstrating apple green birefringence in polarized light, consistent with amyloidosis.
CRIC2021-5673364.005.jpg
PMC8526272_01_CRIC2021-5673364.005.jpg
fig5
Finally, a cardiac biopsy was positive for amyloid with Congo red staining (Figure 5) and demonstrated AL amyloid on mass spectrometry.