PMC7249551_01
Electrocardiogram with low-voltage, left axis deviation, first-degree AV block.
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Electrocardiogram (Figure 1) showed normal sinus rhythm with low voltage, but no signs of ischemia.
Top image on admission 04/17: image showing (a) concentric LVH with profound septal hypertrophy, (b) diastolic dysfunction on transmitral Doppler flow with E/A of 3.5. Bottom image on 09/18: increase myocardial echogenicity, (c) severe dilated left atrium, (d) restrictive filling pattern with grade III diastolic dysfunction.
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Transthoracic echocardiography (TTE) (Figure 2) revealed a progressive decline in left ventricular ejection fraction (LVEF) to 25%-35%.
Technetium pyrophosphate NM bone scan spect reveals abnormal radiotracer uptake within the cardiac myocardium that is greater than bone uptake. Findings were characteristic of grade III cardiac amyloidosis.
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Follow-up nuclear bone imaging (Figure 3) revealed increased cardiac uptake greater than bone, suggestive of grade III CA.