Fatal perioperative myocardial infarction in four patients with cardiac amyloidosis.

AMYLOIDOSIS is caused by the accumulation of amyloid fibrils in vital organs, leading to functional disturbances. Approximately 40% of patients with primary amyloidosis have had cardiac amyloidosis. In cardiac amyloidosis, right heart failure is the predominant sign, whereas left heart function is preserved until late in the disease. Because of the cardiac involvement, when patients with cardiac amyloidosis undergo surgery, anesthesia can present special risks. In addition to the conduction disturbance and cardiac failure that are the main causes of death in cardiac amyloidosis, ischemic changes have been reported extensively. However, there have been no reports concerning perioperative myocardial ischemia in patients with cardiac amyloidosis. Here we report on four patients with cardiac amyloidosis who developed fatal perioperative cardiac arrest resulting from myocardial infarction.