ECG-Facilitated Detection of Light Chain Cardiac Amyloidosis in Long-Standing MGUS
Jakub Piwowarski1, Gina Barzen1, Stephan Bohl2
1Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Charité Mitte, Berlin, Germany; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany; Amyloidosis Center Charité Berlin (ACCB), Amyloidosis Center of Charité, Campus Charité Mitte, Campus Benjamin Franklin, and Campus Virchow Klinikum, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
Abstract:
A 76-year-old outpatient with light-chain monoclonal gammopathy of undetermined significance presented for evaluation of new-onset, nonspecific symptoms. Paraproteinemia remained stable for over 25 years without prior signs of organ manifestation. Physical examination was unremarkable. To complete routine diagnostics, a 12-lead electrocardiogram was performed, demonstrating features suggestive of amyloidosis, including low QRS voltages and an unexplained anterior pseudoinfarction pattern. It contributed to initiating further evaluation, leading to the diagnosis of light-chain cardiac amyloidosis. TAKE-HOME MESSAGE: This case highlights the potential of electrocardiography as an easily accessible tool for increasing suspicion of cardiac complications in long-standing monoclonal gammopathy of undetermined significance, even in clinically inconclusive cases.
