PMC8238623_01
Electrocardiogram on admission showing sinus rhythm with low voltage, prior infarct of anteroseptal regions, and T-wave inversions in lateral leads.
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Electrocardiogram revealed sinus rhythm with first-degree AV block, low voltage, old infarct with Q waves in anteroseptal leads, and T-wave inversions in anterolateral leads (Figure 1).
Echocardiography shows low global longitudinal cardiac strain (-13.4%) with "cherry on top" pattern (normal value for global longitudinal strain is -20% and below in healthy individuals). Strain pattern is suggestive of possible cardiac amyloidosis.
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III restrictive diastolic filling pattern suggestive of increased left atrial pressure, preserved ejection fracture (60-65%), dilated inferior vena cava with <50% respiratory variation, and severe concentric left ventricular hypertrophy concerning for infiltrative process per strain pattern (Figure 2). Interventricular septum was 1.5 cm (normal: 0.7-1.1 cm), and posterior wall thickness was 1.4 cm (normal: 0.7-1.1 cm).
Electrocardiogram after cardiac arrest with junctional bradycardia and premature ventricular complexes.
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On the day after admission, she developed unstable ventricular tachycardia but spontaneously converted after two minutes to junctional bradycardia (Figure 3).
Autopsy of cardiac muscle with increased subpericardial fat asymmetrically concentrated more towards the right ventricle compared to the left ventricle.
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They authorized the autopsy which subsequently revealed gross cardiomegaly and left ventricular hypertrophy (Figure 4).
(a) Infiltrative amyloid deposits noted among the myocytes on hematoxylin and eosin stain. (b) Congo red stain with apple-green birefringence within the right and left ventricle tissues.
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Congo red staining of both ventricular and hepatic tissue revealed amyloid fibrils with apple-green birefringence (Figure 5).