Key result
A 72-year-old man with cardiac amyloidosis presented with recurrent ischaemic strokes, including an episode post-elective cardioversion while on anticoagulation.
Case Report (n=1)
Highlights a case of cardiac amyloidosis presenting with recurrent ischaemic strokes despite anticoagulation, emphasizing the need to consider infiltrative cardiomyopathies in such presentations.
Recurrent strokes despite anticoagulation may indicate cardiac amyloidosis; leaves open optimal antithrombotic strategies in infiltrative disease.
A 72-year-old man presented to our service with sudden onset right-sided weakness, aphasia and gaze palsy with diplopia. CT angiogram demonstrated an acute thrombotic occlusion of the distal basilar artery, a basilar infarct and the patient underwent successful thrombectomy. ECG and telemetry demonstrated slow atrial fibrillation (AF). His transthoracic echocardiogram (TTE) showed a reduced ejection fraction of 25% with global hypo-kinesis, a dilated left ventricle (LV) and LV hypertrophy (LVH). Repeat TTE appeared suspicious for an infiltrative cardiomyopathy with LVH and a speckled appearance to the myocardium. Approximately 10 months later, he suffered another ischaemic stroke post-elective cardioversion for AF while on anticoagulation. Cardiac MRI demonstrated areas of delayed gadolinium enhancement consistent with amyloidosis. Fat pad biopsy was positive for amyloidosis. Our patient has made an excellent recovery from the ischaemic strokes and is being managed in our heart failure clinic.
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Suleiman et al. (2020) conducted a case report in Cardiac amyloidosis and recurrent ischaemic strokes (n=1). Cardiac amyloidosis was evaluated. A 72-year-old man with cardiac amyloidosis presented with recurrent ischaemic strokes, including an episode post-elective cardioversion while on anticoagulation.
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