Case report: recurrent chest pain as initial manifestation of rapidly progressing light-chain cardiac amyloidosis with microvascular infiltration—a novel red flag associated with poor outcomes

TL;DR

A case report highlights chest pain as an early warning sign of a deadly heart condition caused by amyloid infiltration, which can lead to severe outcomes if not detected.

Contribution

Identifies recurrent chest pain as a novel red flag for microvascular amyloid infiltration in light-chain cardiac amyloidosis.

Findings

Recurrent angina was the initial manifestation of rapidly progressing cardiac amyloidosis.

Post-mortem confirmed extensive microvascular amyloid infiltration despite unobstructed coronary arteries.

The patient's condition rapidly deteriorated, leading to cardiogenic shock and death within 6 months.

Abstract

Angina due to microvascular amyloid infiltration is an under-recognized early red flag of infiltrative disease and should be investigated as a predictor of poor outcomes.

A 73-year-old man with cardiovascular risk factors and a history of treated obstructive coronary artery disease presented 10 months later with recurrent angina. His condition progressively worsened, with the development of severe dyspnoea. Within 6 months, he succumbed to cardiogenic shock in the presence of severe biventricular dysfunction and unobstructed coronary arteries. Post-mortem diagnosis revealed AL cardiac amyloidosis with massive myocardial infiltration and extensive microvascular amyloid deposits.

This case underscores chest pain as a critical clinical marker, potentially indicating microvascular amyloid infiltration in patients with light-chain cardiac amyloidosis, particularly those with unobstructed coronary arteries. Its assessment may also have implications for future therapies.

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