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Angina with a normal coronary angiogram caused by amyloidosis
D C Whitaker1, M F Tungekar, J E Dussek
1Department of Cardiothoracic Surgery, 6th Floor, New Guy's House, Guy's Hospital, St Thomas Street, London SE1 9RT, UK. donaldc@doctors.org.uk
Heart (British Cardiac Society)
|August 18, 2004
Summary
Severe angina despite normal angiography can indicate cardiac amyloidosis. This rare condition, diagnosed postmortem, carries a poor prognosis and requires clinical awareness for early detection.
Area of Science:
- Cardiology
- Pathology
Background:
- Severe intractable angina pectoris often prompts investigation for obstructive coronary artery disease.
- Normal coronary angiography typically excludes significant atherosclerotic coronary artery disease as a cause of angina.
Observation:
- A patient with severe angina pectoris underwent video-assisted thoracic sympathectomy after normal coronary angiography.
- The patient subsequently died of heart failure post-procedure.
Findings:
- Postmortem examination revealed microvascular cardiac amyloidosis as the underlying cause of the patient's symptoms.
- This diagnosis was not identified prior to the patient's death.
Implications:
- Clinicians should consider microvascular cardiac amyloidosis in patients with severe, refractory angina and normal coronary angiograms.
- Early recognition of cardiac amyloidosis is crucial, as it is associated with a poor prognosis and specific management considerations.
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