SHM Converge Scientific Abstract ePoster Gallery-Anticoagulation for Thromboembolic Disease in the Setting of Cardiac Amyloidosis

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This case describes a 72-year-old woman with progressive weakness, dyspnea, weight loss, falls, bruising, and dysphagia, who was found to have suspected systemic amyloidosis with cardiac involvement. Her workup showed anemia, worsening renal function, heavy proteinuria, extremely elevated BNP and D-dimer, and CT angiography revealing acute bilateral segmental pulmonary emboli with right heart strain. She also developed atrial fibrillation with rapid ventricular response after admission.<br /><br />Physical exam showed classic amyloidosis findings, including periorbital purpura, macroglossia, enlarged submandibular glands, anasarca, and diffuse ecchymoses. She was started on heparin for thromboembolic disease. Further evaluation confirmed AL (lambda) amyloid deposition on fat aspirate with Congo red staining and mass spectrometry. Echocardiography showed biventricular wall thickening and an abnormal global longitudinal strain pattern with apical sparing, supporting cardiac amyloidosis.<br /><br />Despite appropriate indications for anticoagulation—pulmonary embolism and atrial fibrillation—the patient’s course was complicated by progressive renal failure, respiratory failure from volume overload, and a dramatic hemoglobin drop to 5.9 mg/dL without an identified bleeding source. Heparin was stopped, and she transitioned to comfort care, dying on hospital day five.<br /><br />The authors emphasize that cardiac amyloidosis carries both thrombotic and bleeding risks. While anticoagulation is recommended for active thromboembolic disease, this case highlights the need to balance benefit against bleeding risk on a patient-by-patient basis. It also raises the unresolved question of whether patients with cardiac amyloidosis but no active thrombosis should receive preventive antithrombotic therapy, and if so, which agent is safest and most effective.

Asset Subtitle

Kevin Stanko

Meta Tag

Author List Christina Moe, Jack McHugh, Kevin Stanko, Samuel B. Huxley

Category Clinical Vignettes

Concept Cardiac Amyloidosis

Concept Anticoagulation

Concept Thromboembolic Risk

Concept Atrial Fibrillation

Concept Bleeding Risk

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Kevin Stanko

Track Adult

Keywords

amyloidosis

cardiac amyloidosis

AL lambda amyloid

pulmonary embolism

atrial fibrillation

anticoagulation

bleeding risk

periorbital purpura

macroglossia

proteinuria

Cardiac Amyloidosis

Anticoagulation

Thromboembolic Risk

Atrial Fibrillation

Bleeding Risk