Cardiac Amyloidosis: from Heart Failure to Multiple Myeloma, a Case Report

Cardiac amyloidosis is an underdiagnosed condition associated with a poor prognosis, likely leading to heart failure, malignant arrhythmias and death. A high index of suspicion should be maintained in regards to clinical, electrocardiographic and echocardiographic changes, as the “gold standard” for diagnosis, endomyocardial biopsy is often unavailable. Another challenge resides in the limited treatment options, with a relative contraindication to the use of betablockers, calcium channel blockers, angiotensin-converting enzyme inhibitors and digoxin. We are presenting the case of a patient with heart failure, in whom echocardiography with speckle tracking and cardiac magnetic resonance played an important role in diagnosing cardiac amyloidosis and underlying multiple myeloma. Despite a poor prognosis based on biomarkers (troponin and NTproBNP) and global longitudinal strain, as well as ineligibility for stem cell transplant the patients survived for another 5 years.