Key result
A patient with primary amyloidosis exhibited failure of sympathetic and parasympathetic reflexes, diffuse myocardial dysfunction, and lactate production despite normal coronary arteries.
Case Report (n=1)
Highlights the complex management of primary amyloidosis with concurrent autonomic dysfunction and heart failure, suggesting microvascular or diffusion-related myocardial ischemia.
May indicate microvascular ischemia in amyloid cardiomyopathy with autonomic failure; single case leaves generalizability and management implications open.
A patient with orthostatic hypotension and congestive heart failure had primary amyloidosis. Study of autonomic function showed failure of both sympathetic and parasympathetic reflexes. Diffuse myocardial dysfunction was demonstrated by cardiac catheterization. Lactate production was detected despite arteriographically normal coronary arteries at rest and with isoproterenol stimulation. It is suggested that myocardial ischemia may be related to small-vessel infiltration by amyloid, diffusion block at the capillary level by amyloid, or myocardial hypertrophy. The therapeutic implications of balancing the need for an increased blood volume to compensate for the autonomic dysfunction against the need for a decreased preload in treatment of heart failure are discussed.
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Capone et al. (1972) conducted a case report in Primary amyloidosis with orthostatic hypotension and congestive heart failure (n=1). Primary amyloidosis was evaluated on Autonomic function and myocardial dysfunction. A patient with primary amyloidosis exhibited failure of sympathetic and parasympathetic reflexes, diffuse myocardial dysfunction, and lactate production despite normal coronary arteries.
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