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Cardiac Amyloidosis Presenting as Microvascular Angina

A Case Report

Departments of Pathology, and Laboratory Medicine, Kumamoto University School of Medicine, Kumamoto, Japan.Departments of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan.

Yuji Mizuno, MD

Departments of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan.

Susumu Ohkawara, MD

Departments of Pathology Medicine, Kumamoto University School of Medicine, Kumamoto, Japan.

Kenichi Tsujita, MD

Departments of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan.

Yukio Ando, MD

Departments of Laboratory Medicine, Kumamoto University School of Medicine, Kumamoto, Japan.

Masaru Yoshinaga, MD

Departments of Pathology Medicine, Kumamoto University School of Medicine, Kumamoto, Japan.

Hirofumi Yasue, MD

Departments of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan.

Cardiac amyloidosis usually presents with heart failure, but rarely leads to coronary insuffi ciency. The authors report a case of a 69-year-old Japanese woman with cardiac amyloidosis presenting as microvascular angina. She had exertional angina with positive exercise test and normal coronary angiograms. However, heart failure developed, and she died 3 years after symptom onset. On autopsy, coronary arteries were patent. In contrast to that of the epicar dial coronary arteries, histologic examination of the heart revealed severe obstructive alter ations of the intramural coronary arteries with amyloid. Furthermore, amyloid was present mainly in the endocardium and the intramural coronary arteries, but there was little present in the myocardium. This case was a rare AL amyloidosis. There have been only 4 reported cases of cardiac amyloidosis that presented with exertional angina, a positive exercise test, and normal coronary angiograms and histologic examination.

Angiology, Vol. 52, No. 4, 273-278 (2001)
DOI: 10.1177/000331970105200407


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