Heart affected by amyloidosis – a case study (RCD code: III-3A.2)

We present a case of a 65-year old woman, who was admitted to hospital due to recurrent pulmonary oedema. Patient's history included chronic obstructive pulmonary disease. Echocardiography revealed a concentric hypertrophy of the left ventricle walls without the narrowing of the outflow tract, accompanied by the mild/moderate mitral stenosis, preserved systolic and mildly impaired diastolic function of the left ventricle. Those comorbidities were not severe but their coexistence contributed to rapid heart failure progression. During another admission for pulmonary oedema the patient had cardiac arrest in the mechanism of the pulseless electrical activity, which triggered the diagnostics of amyloidosis. Right heart catheterization was performed showing an unusually high wedge pressure. Histological analysis confirmed the diagnosis of amyloid light-chain (AL) amyloidosis, so the patient was scheduled for the first course of chemotherapy. Unfortunately, shortly after discharge, the patient developed pulmonary oedema and died before an admission to the hospital. This case shows the adverse course of the disease, fast progression of unspecific symptoms that may attribute to multiple comorbidities. JRCD 2015; 2 (5): 156–160