A Case Report and Literature Review of Cardiac Amyloidosis: The Great Pretender Masquerading As Acute Coronary Syndrome

Cardiac amyloidosis is a rare condition characterized by the accumulation of misfolded proteins in the heart. It is often associated with heart failure with preserved ejection fraction, restrictive cardiomyopathy, aortic stenosis, conduction disorders, and arrhythmias, particularly atrial fibrillation. We present the case of a 71-year-old male patient admitted to the cardiology department with crescendo angina, Q waves on the electrocardiogram, and elevated troponin levels. The initial working diagnosis was late-presenting ST-elevation myocardial infarction. However, coronary angiography revealed no significant coronary artery disease, and further diagnostic workup led to the diagnosis of wild-type transthyretin amyloidosis. This case illustrates an atypical presentation of cardiac amyloidosis, masquerading as acute coronary syndrome. It highlights the importance of recognizing key red flags that should raise suspicion for this diagnosis and guide further investigation. Additionally, we review the current literature to explore the pathophysiological mechanisms underlying chest pain in cardiac amyloidosis, offering insights into this often underdiagnosed condition.