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Primary amyloidosis and syncope
J Rodriguez Reguero1, G Iglesias Cubero, J Rubín
1Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
Insights
Cardiac amyloidosis can cause dizziness and fainting (syncope) in older adults. Diagnosis requires echocardiography and biopsy, even with normal heart rhythm tests.
Area of Science:
- Cardiology
- Neurology
Background:
- Cardiac amyloidosis is a progressive disease.
- Peripheral neuropathy can be an early sign.
Observation:
- A 59-year-old presented with dizziness and exertional syncope.
- Echocardiography revealed myocardial hypertrophy.
- Patient had a history of peripheral neuropathy.
Findings:
- Endomyocardial biopsy confirmed cardiac amyloidosis.
- Exercise and Holter tests showed no rhythm or conduction issues.
- Head-up tilt test indicated a vasovagal response.
Implications:
- Highlights the importance of considering cardiac amyloidosis in patients with unexplained syncope and hypertrophy.
- Suggests that vasovagal responses can coexist with or be exacerbated by cardiac amyloidosis.
- Emphasizes the diagnostic value of endomyocardial biopsy in confirming cardiac amyloidosis.
Abstract:
A 59-year-old caucasian consulted our clinic with symptoms of dizziness and exertional syncope. The combination of myocardial hypertrophy diagnosed by echocardiography, together with a history of peripheral neuropathy made us suspect cardiac amyloidosis which was later proven by endomyocardial biopsy. A graded exercise test and two Holter monitoring studies revealed neither rhythm nor conduction abnormalities. A head-up tilt test revealed a vasovagal vasodepressor response.