AL Amyloidosis Presenting as Heart Failure: A Case Report and Review of Literature

Restrictive cardiomyopathy secondary to cardiac amyloidosis is an underdiagnosed cause of heart failure, and it is associated with significant morbidity and mortality. Advances in cardiac imaging with the use of cardiac magnetic resonance and technetium pyrophosphate scintigraphy have helped early diagnosis and treatment of amyloidosis. We hereby report the case of a 55-year-old patient who presented with symptoms of acute congestive heart failure on a background of diabetes, hypertension, and chronic kidney disease. The discordant findings of low voltage complexes on electrocardiogram with concentric left ventricular hypertrophy and abnormal global longitudinal strain pattern on two-dimensional echocardiogram made us suspect cardiac amyloidosis. Cardiac magnetic resonance imaging findings (diffuse thickening of both ventricles, interatrial, and interventricular septum) favored amyloidosis. Serum protein electrophoresis and flow cytometry findings suggested AL type of amyloidosis. A diagnosis of AL-type cardiac amyloidosis was made, and the patient was treated with a cyclophosphamide + bortezomib + dexamethasone regimen.