Lasam Glenmore, Lasam Maria Kristina Cassandra, Alam Loba
Cardiovascular Disease, Stockton Cardiology Medical Group, Manteca, USA.
Biomedical Science Pathway, Mountain House High School, Mountain House, USA.
Cureus. 2025 Feb 22;17(2):e79474. doi: 10.7759/cureus.79474. eCollection 2025 Feb.
A case of a 67-year-old male with a history of hypertension, diabetes, and hyperlipidemia presented to the hospital because of chest discomfort, preceded by a gradual onset of diminished exercise tolerance, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and bilateral lower extremity swelling. An electrocardiogram showed no acute ischemic changes, though he had very mild troponin elevation. Cardiac catheterization showed nonobstructive coronary artery disease. A transthoracic echocardiogram revealed reduced left ventricular systolic function with elevated left ventricular filling pressure. Cardiac magnetic resonance imaging demonstrated abnormal contrast kinetics, consistent with cardiac amyloidosis. A technetium-99m pyrophosphate scan unveiled diffuse cardiac amyloidosis of the transthyretin type. Myocardial biopsy showed amyloid deposition by positive Congo red stain and confirmed by apple-green birefringence on polarized light. He was started on medical therapy for heart failure and coronary artery disease. He was eventually started on an oral transthyretin stabilizer that significantly improved his heart failure symptoms and exercise capacity, with no readmission to the hospital since then. He had been evaluated and deemed a candidate for cardiac transplantation.
一名67岁男性，有高血压、糖尿病和高脂血症病史，因胸部不适入院。在此之前，他的运动耐量逐渐下降，出现劳力性呼吸困难、端坐呼吸、阵发性夜间呼吸困难和双侧下肢肿胀。心电图显示无急性缺血性改变，不过肌钙蛋白有非常轻微的升高。心脏导管检查显示非阻塞性冠状动脉疾病。经胸超声心动图显示左心室收缩功能降低，左心室充盈压升高。心脏磁共振成像显示造影剂动力学异常，符合心脏淀粉样变性。锝-99m焦磷酸盐扫描显示转甲状腺素蛋白型弥漫性心脏淀粉样变性。心肌活检显示刚果红染色阳性的淀粉样沉积，并经偏振光下苹果绿双折射证实。他开始接受心力衰竭和冠状动脉疾病的药物治疗。最终，他开始服用口服转甲状腺素蛋白稳定剂，这显著改善了他的心力衰竭症状和运动能力，此后未再入院。他已接受评估并被认为是心脏移植的候选人。
