Cardiac amyloidosis presenting with recurrent ischaemic strokes
Suleiman Suleiman1, John Joseph Coughlan2, David Moore3
1Department of Cardiology, Tallaght University Hospital, Dublin, Ireland suleimas@tcd.ie.
BMJ Case Reports
|February 26, 2020
Summary
This case study highlights a patient with a basilar artery stroke and atrial fibrillation (AF) who was later diagnosed with cardiac amyloidosis. Early diagnosis and management of amyloidosis are crucial for preventing recurrent cardiovascular events.
Area of Science:
- Cardiology
- Neurology
- Genetics
Background:
- A 72-year-old male presented with acute ischemic stroke symptoms, including right-sided weakness, aphasia, and diplopia.
- Initial CT angiogram revealed a thrombotic occlusion in the distal basilar artery, leading to a successful thrombectomy.
Observation:
- Electrocardiogram (ECG) and telemetry indicated slow atrial fibrillation (AF).
- Transthoracic echocardiogram (TTE) showed a reduced ejection fraction (25%), dilated left ventricle (LV), and left ventricular hypertrophy (LVH).
- Subsequent TTE suggested an infiltrative cardiomyopathy with LVH and myocardial speckling.
Findings:
- The patient experienced a second ischemic stroke 10 months later, despite anticoagulation and following AF cardioversion.
- Cardiac MRI revealed delayed gadolinium enhancement, indicative of cardiac amyloidosis.
- Fat pad biopsy confirmed the diagnosis of amyloidosis.
Implications:
- This case underscores the importance of considering cardiac amyloidosis in patients with cryptogenic stroke and heart failure.
- Early diagnosis and appropriate management of amyloidosis can prevent recurrent ischemic events and improve patient outcomes.
- Multidisciplinary management in heart failure clinics is essential for patients with co-existing stroke and cardiac conditions.
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