Cardiogenic Shock Patient Found to Have Cardiac Amyloidosis and Concurrent Multiple Myeloma

Cardiac amyloidosis is an under-recognized cause of heart failure.

A 61-year-old man presented with acute decompensated heart failure and cardiogenic shock requiring peripheral venoarterial extracorporeal membrane oxygenation support. Endomyocardial biopsy revealed a diagnosis of light-chain cardiac amyloidosis. Work-up for incidentally noted hypercalcemia also revealed a rare diagnosis of concurrent multiple myeloma. Unfortunately, the patient clinically deteriorated with limited treatment options and ultimately died in hospital.

We discuss this case in relation to the complexities of recognizing and making a diagnosis of cardiac amyloidosis as well as the atypical presentation with cardiogenic shock and concurrent multiple myeloma.

A broad differential diagnosis is required in patients with heart failure and worsening cardiogenic shock, including under-recognized etiologies such as cardiac amyloidosis. Though rare, cardiac amyloidosis can co-occur with multiple myeloma, and making the diagnosis early is important to inform available treatment options.