cardiac amyloidosis presenting as recurrent acute coronary syndrome with unobstructed coronary arteries: case report

Amyloidosis is a systemic disorder characterized by the deposition of mis-folded protein molecules within various organs. Cardiac involvement may be the presenting feature of this condition or may be identified incidentally during investigation for amyloidosis affecting other organs. The presence and severity of cardiac involvement varies with the type of amyloidosis. Irrespective of the subtype, patients with cardiac amyloidosis usually present with symptoms of heart failure with echocardiography showing features of restrictive cardiomyopathy. The usual cardiac symptoms noted in patients with amyloidosis include dyspnea, peripheral edema, and palpitations secondary to arrhythmias.1 Chest pain secondary to myocardial ischemia is an unusual presentation of cardiac amyloidosis, and is attributed to the deposition of protein molecules in the coronary microvasculature. We describe the case of a patient who presented with recurrent cardiac ischemia secondary to amyloidosis.