CARDIAC AMYLOIDOSIS WITH INTRACTABLE HEART FAILURE

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Amyloidosis is characterized by the deposition of insoluble abnormal protein in extracellular space that results organ's functioning. The incidence cardiac amyloidosis 55 /100,000 person-years while prevalence 17/100,000 person–years. (1) It can manifest with heart failure, (HF) conduction abnormalities, or pericardial effusion. (2) Early diagnosis imperative as it a life-threatening disease. We report case patient who presented failure. CASE PRESENTATION: A 73-year-old man history significant for hypertension, atrial fibrillation, and chronic kidney disease stage 4, complaints worsening shortness breath. Physical exam was notable elevated jugular venous pulse hypotension. Lab workup unremarkable except BNP (910 pg/ml). He underwent right left catheterization remarkable low output increased filling pressure heart, without any coronary artery obstruction. Nuclear technetium pyrophosphate scan showed diffuse uptake ventricle suggestive transthyretin amyloidosis. (Fig 1) treated IV diuretics milrinone blood support. deemed not suitable candidate transplant given multiple comorbidities. His function deteriorated intractable HF, he died arrest after his discharge. DISCUSSION: Cardiac be diagnosed help different imaging modalities including EKG, echocardiography, MRI, radionuclide bone scintigraphy. MRI scintigraphy are choice diagnosing two modalities' sensitivity specificity. (3). therapy involvement aimed at treating congestive failure preventing progression amyloid deposits. Heart associated fluid, salt restriction, diuretics. Beta-blockers ACE inhibitors should avoided they exacerbate symptoms Unfortunately, many end-organ damage treatment limited. definitive transplantation. (4) CONCLUSIONS: Clinicians keep their minds newly people do have REFERENCE #1: 1)Gilstrap LG, Dominici F, Wang Y, et al. Epidemiology Amyloidosis-Associated Failure Hospitalizations Among Fee-for-Service Medicare Beneficiaries United States. Circ Fail. 2019;12(6): e005407. doi:10.1161/CIRCHEARTFAILURE.118.005407 #2: 2)Castaño A, Narotsky DL, Hamid N, Unveiling its predictors among elderly patients severe aortic stenosis undergoing transcatheter valve replacement. Eur J. 2017;38(38):2879-2887. doi:10.1093/eurheartj/ehx350 #3: 3) Fontana M, Martinez-Naharro Hawkins PN. Staging With CMR: Understanding Different Phenotypes. JACC Cardiovasc Imaging. 2016;9(11):1278-1279. DOI: 10.1016/j.jcmg.2016.02.035. 4) Yamamoto H, Yokkaichi T. Transthyretin amyloidosis: an update on treatment. ESC 2019;6(6):1128-1139. doi:10.1002/ehf2.12518 DISCLOSURES: No relevant relationships Junaid mir, source=Web Response Sharon Scott, source=Admin input