Delayed diagnosis of cardiac amyloidosis in a West African octogenarian

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Pathways

Background:

• Left ventricular hypertrophy (LVH) is a common cardiac finding, often presumed to be caused by hypertension, particularly in the African region.
• Accurate diagnosis of LVH etiology is crucial for effective patient management.
• Multimodality cardiac imaging is essential in the diagnostic process for complex cases.

Observation:

• An 80-year-old West African male initially presented with findings suggestive of heart failure with preserved ejection fraction attributed to hypertensive heart disease.
• Initial echocardiography three years prior supported the presumptive diagnosis of hypertensive heart disease.
• A stepwise re-evaluation was initiated, including a detailed clinical history review.

Findings:

• The patient was ultimately diagnosed with cardiac amyloidosis.
• This diagnosis was established through a comprehensive approach utilizing multimodality cardiac imaging.
• The initial presumptive diagnosis of hypertensive heart disease was revised.

Implications:

• This case underscores the importance of considering less common etiologies for LVH, even with a history of hypertension.
• Multimodality imaging is critical for differentiating causes of LVH and achieving accurate diagnoses.
• A thorough diagnostic approach can prevent misdiagnosis and ensure appropriate treatment for conditions like cardiac amyloidosis.