Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece.
Rev Cardiovasc Med. 2021 Sep 24;22(3):883-889. doi: 10.31083/j.rcm2203094.
Amyloid light-chain (AL) amyloidosis is a multisystemic disease. Among its clinical manifestations, vein and arterial thromboembolic events are included. We report the unusual case of a 57-year-old female patient with AL amyloidosis presenting with an ST segment elevation myocardial infarction due to coronary artery embolization (CE). The patient reported a history of exertional dyspnoea along with episodes of haemoptysis for the last few months. Her coronary angiography demonstrated embolization of the distal segment of the left anterior descending artery. The main findings of her cardiac ultrasound included concentric left ventricular hypertrophy, mildly impaired left ventricular systolic function, left atrium enlargement and a restrictive-like filling pattern, while her chest computed tomography (CT) demonstrated bilateral pleural effusions. Cardiac magnetic resonance imaging that was performed afterwards, indicated areas of microvascular infarction, a small apex infarct and findings compatible with possible amyloidosis, a diagnosis that was confirmed later by fat tissue biopsy. Patient was referred for an oncology consultation, started therapy with direct oral anticoagulants, angiotensin converting enzyme inhibitor, statins and anti-plasma cell therapy. She has been improving since then and has been free of cardiovascular events for a follow-up period of 12 months. Cardiologists ought to be aware of amyloidosis as a rare but possible cause of coronary embolization, while close collaboration with oncologists is required for the establishment of the correct diagnosis.
淀粉样轻链（AL）淀粉样变性是一种多系统疾病。其临床表现包括静脉和动脉血栓栓塞事件。我们报告了一例不常见的 57 岁女性 AL 淀粉样变性患者，因冠状动脉栓塞（CE）导致 ST 段抬高型心肌梗死。该患者自述在过去几个月中一直有劳累性呼吸困难和咯血病史。她的冠状动脉造影显示左前降支远端节段栓塞。她的心脏超声的主要发现包括左心室肥厚呈向心性、左心室收缩功能轻度受损、左心房增大和限制样充盈模式，而她的胸部计算机断层扫描（CT）显示双侧胸腔积液。随后进行的心脏磁共振成像显示有微血管梗死区、心尖小梗死区和可能淀粉样变性的发现，后来通过脂肪组织活检得到了确诊。患者随后被转介到肿瘤科进行咨询，开始接受直接口服抗凝剂、血管紧张素转换酶抑制剂、他汀类药物和抗浆细胞治疗。此后，她的病情一直在改善，并且在 12 个月的随访期间没有发生心血管事件。心脏病专家应该意识到淀粉样变性是冠状动脉栓塞的一种罕见但可能的原因，同时需要与肿瘤专家密切合作以确立正确的诊断。
