Truth will out: a rare case of amyloid cardiomyopathy

Clinically apparent heart disease or cardiac amyloidosis is uncommon in secondary amyloidosis. 1 Secondary amyloidosis may complicate chronic inflammatory diseases and is rarely associated with other causes, for example, neoplasms. 1 In the diagnosis of cardiac amyloidosis, the characteristic echocardiographic finding of an increased echogenicity of the myocardium has limited specificity and sensitivity. 2 In contrast, CMR imaging with a distinctive late gadolinium enhancement pattern can provide evidence strongly suggestive of cardiac amyloid deposition and can be used to guide myocardial biopsies, which have a higher sensitivity compared with subcutaneous fat or rectal biopsies. 2 3 In our patient, the characteristic CMR findings proved to be pivotal for the diagnosis of the secondary or AA amyloidosis with cardiac manifestation.