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(Circulation. 1998;97:2093-2094.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Amyloidosis With Cardiac Involvement

Ho-Joong Youn, MD; Jang Seong Chae, MD; Kyo Young Lee, MD; ; Soon Jo Hong, MD

From the Department of Internal Medicine (H.-J.Y., J.S.C., S.J.H.), and Clinical Pathology (K.Y.L.), The Catholic University of Korea.

Correspondence to Ho-Joong Youn, MD, Department of Internal Medicine, The Catholic University of Korea, St Mary's Hospital, #62, Yoido-Dong, Youngdungpo-Gu, Seoul, 150-010, Korea.

A 59-year-old woman was admitted because of lethargy. She had been treated for heart failure for 5 years before admission, which progressed to include lower-extremity edema as well as orthopnea and nocturnal dyspnea.

The serial ECGs and echocardiographic findings are summarized in Figs 1 and 2. Forearm skin, rectal (Fig 3), and endomyocardial biopsies (Fig 4) were performed.

View larger version (86K): [in this window] [in a new window]   Figure 1. Serial ECG changes. Top, Sinus rhythm at 80 bpm with first-degree AV block (PR interval, 0.22 second) and right bundle-branch block. Middle, Sinus rhythm at 90 bpm with first-degree AV block (PR interval, 0.24 second), right bundle-branch block, and left axis deviation. Bottom, Complete AV block at 48 bpm and low voltage.

View larger version (138K): [in this window] [in a new window]   Figure 2. Top, Serial two-dimensional echocardiographic findings. Thickening of all myocardial walls and valves; "patch amorphous, high-intensity echoes" in left ventricular myocardium; and a small pericardial effusion were noted (top left). Bottom, Serial M-mode echocardiography showed gradual increase of interventricular septal, left ventricular posterior wall, and right ventricular wall thickness.

View larger version (128K): [in this window] [in a new window]   Figure 3. Lamina propria and mucosa of rectum (left) and dermis of skin (right) showing yellow-green birefringence after Congo red stain under polarizing microscopic examination (x100).

View larger version (123K): [in this window] [in a new window]   Figure 4. Top left, Amyloid material stained red within the cardiac muscle cells with Congo red stain (x100). Top right, Typical yellow-green birefringence after Congo red stain under polarizing microscopic examination (x100). Bottom, Positive reaction of amyloid material between atrophic cardiac muscle cells with monoclonal murine antibody of amyloid associated protein (x200).

On the basis of our findings (Figs . . . [Full Text of this Article]