SHM Converge Scientific Abstract ePoster Gallery-When a Common Presentation of Heart Failure Leads to the Uncommon Diagnosis of Cardiac Amyloidosis Case Reprt

Pdf Summary

This case report describes a 65-year-old woman with hyperlipidemia who presented with worsening shortness of breath after being treated for presumed pneumonia. Despite antibiotics, her symptoms progressed, and she was found to be volume overloaded in the emergency department. Initial testing showed elevated BNP, normal white blood cell count, and CT pulmonary angiography negative for pulmonary embolism but notable for cardiomegaly, septal thickening, and bilateral pleural effusions. She was admitted with a working diagnosis of heart failure.<br /><br />Further inpatient evaluation revealed findings concerning for cardiac amyloidosis. Transthoracic echocardiogram showed increased ventricular wall thickness, valvular thickening, effusion, and restrictive diastolic dysfunction. Cardiac MRI demonstrated septal hypertrophy and diffuse non-ischemic fibrosis. Laboratory studies showed markedly elevated light chains, especially lambda free light chains. A myeloma workup, bone marrow biopsy, and nuclear medicine amyloid scan were performed to distinguish AL amyloidosis from multiple myeloma and transthyretin amyloidosis. Ultimately, she was diagnosed with light-chain (AL) cardiac amyloidosis.<br /><br />Her symptoms improved with IV diuresis during hospitalization, but guideline-directed medical therapy for heart failure was not started because of concern for cardiac amyloidosis and its poor tolerance of standard HF medications. After discharge, she was started on chemotherapy, but her disease progressed rapidly. She entered hospice two months later and died shortly afterward.<br /><br />The case highlights several key lessons: avoid anchoring bias when symptoms persist after an initial diagnosis; maintain a high index of suspicion for cardiac amyloidosis in patients with HFpEF and atypical imaging findings; and recognize that early diagnosis is crucial because prognosis and treatment differ greatly from other causes of heart failure. AL amyloidosis carries a particularly poor prognosis, making timely recognition and disease-specific therapy essential.

Asset Subtitle

Tricia Keller

Meta Tag

Author List Dana Paine, Drew Logan, Tricia Keller

Category Clinical Vignettes

Concept Cardiac Amyloidosis

Concept Heart Failure with Preserved Ejection Fraction

Concept Heart Failure

Concept AL Amyloidosis

Concept Echocardiography

Distinguished Non-Finalist

Presenter Organization The Ohio State University Wexner Medical Center, Department of Internal Medicine

Presenting Author Tricia Keller

Track Adult

Keywords

cardiac amyloidosis

AL amyloidosis

heart failure

HFpEF

shortness of breath

light chains

lambda free light chains

echocardiogram

cardiac MRI

pleural effusions

Cardiac Amyloidosis

Heart Failure with Preserved Ejection Fraction

Heart Failure

AL Amyloidosis

Echocardiography