Systemic Amyloidosis Masquerading as Intractable Cardiomyopathy.

INTRODUCTION Cardiac amyloidosis is an infiltrative cardiomyopathy in which amyloid protein is deposited throughout the myocardium. It is increasingly recognized as a cause of heart failure with preserved ejection fraction in the elderly. Presenting symptoms include exercise intolerance, fatigue, angina, breathlessness and syncope or pre-syncope.1 Atrial fibrillation is the most common early arrhythmia, with ventricular fibrillation occurring later in the course of the disease.1 This case presents a 79-year-old man with multiple myeloma and non-ischemic cardiomyopathy whose diagnostic tests failed to illustrate the typical findings seen in cardiac amyloidosis, although extensive cardiac amyloid deposition was seen at autopsy. This case highlights the need to pursue myocardial biopsy as the gold standard test if clinical suspicion is high.