Heart failure as the first manifestation of severe non-cardiac disease.

UNLABELLED

Heart failure in patients with rheumatoid arthritis (RA) caused by secondary amyloidosis is now extremely rare.

A CASE REPORT

A 42 year old female patient with rheumatoid arthritis was admitted to our cardiology unit to diagnose and find the cause of her heart failure. Echocardiography showed marked diastolic dysfunction, hypertrophic cardiomyopathy and global longitudinal strain characteristic for cardiac amyloidosis. However, the suspicion of secondary amyloidosis related to her RA was excluded based on negative results of anti-SAA test. Cardiac MRI showed typical changes for cardiac amyloidosis in agreement with the primary echocardiography. Measurement of serum free light chain ratio revealed pattern typical for light chain amyloidosis secondary to multiple myoloma, confirmed by plasmocytosis on bone marrow biopsy and histopathology of salivary gland.

CONCLUSIONS

In patients with cardiac amyloidosis, despite strong clinical suggestions, the definite diagnosis should be always established because it may allow to implement effective treatment.