Unusual Presentation of Cardiac Amyloidosis in a Vietnam Veteran with Agent Orange Exposure

Cardiac amyloidosis typically manifests as restrictive cardiomyopathy, but this case presents an unusual overlap of heart failure with reduced ejection fraction, sustained ventricular tachycardia, and severe coronary artery disease in a largely asymptomatic patient. A 77-year-old male with Agent Orange exposure and a history of recurrent premature ventricular contractions experienced syncope, leading to the diagnosis through multimodal imaging and amyloid workup. The coexistence of infiltrative and ischemic pathology complicated management. This case notes the diagnostic challenges in differentiating cardiac amyloidosis from ischemic cardiomyopathy and highlights the potential role of environmental exposures in disease pathogenesis. Recognition of such atypical presentations is crucial for optimizing diagnostic and therapeutic strategies.