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Systemic amyloidosis presenting with angina pectoris
J Al Suwaidi1, J L Velianou, M A Gertz
1Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
Background:
Manifestations of cardiac amyloidosis may include congestive heart failure and sudden cardiac death. Although vascular involvement in patients with amyloidosis is common, systemic amyloidosis presenting with angina is rare.
Objectives:
To report on patients with systemic amyloidosis presenting with angina pectoris.
Design:
Case series.
Setting:
Academic medical center.
Patients:
Five patients who presented with angina pectoris and normal coronary angiogram as the initial manifestation of systemic amyloidosis.
Measurements:
Endothelial-dependent and endothelial-independent coronary flow reserve.
Results:
All patients had coronary flow reserve abnormalities and subsequently developed congestive heart failure and systemic manifestations of amyloidosis. Histologic evaluation revealed amyloid deposition in the intramyocardial coronary vessels.
Conclusions:
Cardiac amyloidosis can present as angina pectoris associated with coronary flow reserve abnormalities despite normal coronary angiograms. This finding may have major therapeutic and prognostic implications in this patient population.