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Breathless after bypass.

Simon G Pearse1, Constantinos Missouris1, Muhammad Ali Qureshi1

  • 1Department of Cardiology, Wexham Park Hospital, Slough, UK.

BMJ Case Reports
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PubMed
Summary
This summary is machine-generated.

This case highlights cardiac amyloidosis, a condition causing unexplained left ventricular hypertrophy (LVH). Early suspicion and advanced imaging like cardiac MRI are crucial for timely diagnosis and management.

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Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Medical Diagnostics

Background:

  • A 65-year-old man presented with exertional dyspnea and chest discomfort.
  • Initial investigations suggested ischemic heart disease, leading to coronary artery bypass surgery.
  • Post-surgery complications included effusions, and the patient later developed worsening edema and breathlessness.

Purpose of the Study:

  • To report a case of cardiac amyloidosis presenting with unexplained left ventricular hypertrophy (LVH).
  • To emphasize the diagnostic challenges and the importance of considering amyloidosis in specific clinical scenarios.
  • To highlight the role of advanced imaging in diagnosing cardiac amyloidosis.

Main Methods:

  • Clinical presentation and initial diagnostic workup including echocardiography and coronary angiography.
  • Management of surgical complications.
  • Serial echocardiography, ECG, and cardiac MRI for further diagnosis.
  • Assessment for heart transplantation.

Main Results:

  • Coronary angiography revealed three-vessel disease, treated with bypass surgery.
  • Post-operative course was complicated by pericardial and pleural effusions.
  • Progressive left ventricular hypertrophy (LVH) with a bright myocardium and restrictive filling pattern was observed.
  • Cardiac MRI confirmed cardiac amyloidosis, but the patient was unsuitable for transplant due to scarring.

Conclusions:

  • Cardiac amyloidosis should be suspected in patients with unexplained left ventricular hypertrophy (LVH).
  • A high index of suspicion is critical for early diagnosis.
  • Cardiac MRI and biopsy can expedite the diagnosis of cardiac amyloidosis.