Karampela Argyroula, Adamidis Nikos, Adamidi Sofia, Adamidis Sotirios
First Department of Internal Medicine, Athens Medical Group, Athens, GRC.
First Department of Internal Medicine, Sismanogleio Hospital, Athens, GRC.
Cureus. 2024 Jul 8;16(7):e64097. doi: 10.7759/cureus.64097. eCollection 2024 Jul.
Cardiac amyloidosis is a rare but increasingly recognized condition characterized by the deposition of amyloid fibrils in cardiac tissue, leading to structural and functional heart impairment. This infiltrative cardiomyopathy often mimics more common cardiac conditions, posing significant diagnostic challenges. Particularly deceptive is its presentation as non-ST-segment elevation myocardial infarction (NSTEMI), where the clinical overlap necessitates considering amyloidosis in differential diagnoses. A 75-year-old male presented with muscle weakness, respiratory infection symptoms, and elevated cardiac enzymes. His history included a recent hospitalization for NSTEMI, with normal coronary angiography. Initial evaluations showed elevated troponin and CRP levels. A comprehensive cardiac assessment revealed a dilated ascending aorta, moderate systolic dysfunction (left ventricular ejection fraction (LV-EF), 47%), and asymmetrical interventricular septal thickening, suggesting hypertrophic cardiomyopathy or amyloidosis. The patient improved and was referred for further specialized care. Cardiac amyloidosis can mimic acute coronary syndrome (ACS), presenting with chest pain and elevated cardiac biomarkers. Differentiation is critical as amyloidosis involves myocardial infiltration by amyloid proteins, leading to restrictive cardiomyopathy. Advanced imaging techniques like cardiac MRI and nuclear scintigraphy are essential for accurate diagnosis and appropriate management, impacting therapeutic strategies and patient outcomes.
心脏淀粉样变性是一种罕见但越来越被认识到的疾病，其特征是淀粉样原纤维在心脏组织中沉积，导致心脏结构和功能受损。这种浸润性心肌病常常模仿更常见的心脏疾病，带来重大的诊断挑战。特别具有欺骗性的是它表现为非ST段抬高型心肌梗死（NSTEMI），在这种情况下，临床症状的重叠使得在鉴别诊断中必须考虑淀粉样变性。一名75岁男性出现肌肉无力、呼吸道感染症状和心肌酶升高。他的病史包括近期因NSTEMI住院，冠状动脉造影正常。初步评估显示肌钙蛋白和CRP水平升高。全面的心脏评估显示升主动脉扩张、中度收缩功能障碍（左心室射血分数（LV-EF）为47%）以及不对称性室间隔增厚，提示肥厚型心肌病或淀粉样变性。患者病情好转并被转诊接受进一步的专科治疗。心脏淀粉样变性可模仿急性冠状动脉综合征（ACS），表现为胸痛和心脏生物标志物升高。鉴别诊断至关重要，因为淀粉样变性涉及淀粉样蛋白对心肌的浸润，导致限制性心肌病。心脏MRI和核素闪烁扫描等先进成像技术对于准确诊断和恰当管理至关重要，会影响治疗策略和患者预后。
