case_images: PMC9897811_01
case_images: Electrocardiogram showing sinus rhythm (51/min), first degree atrioventricular block (PR interval of 218ms), and left bundle branch block.
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case_images: PMC9897811_01_cureus-0015-00000033364-i01.jpg
case_images: FIG1
case_images: At presentation, his electrocardiogram (ECG) showed first-degree atrioventricular block and left bundle branch block (Figure 1).
case_images: Echocardiography showing grade III diastolic dysfunction with an E/A ratio superior to 2.. B = E wave; A = A wave
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case_images: PMC9897811_01_cureus-0015-00000033364-i02.jpg
case_images: FIG2
case_images: Transthoracic echocardiogram (TEE) revealed the presence of a restrictive/infiltrative cardiomyopathy, showing grade III diastolic dysfunction (Figure 2), concentric severe left ventricular hypertrophy and right ventricular hypertrophy, severe right and left atrial enlargement, thickened heart valves (Figure 3) and interatrial septum, moderate tricuspid regurgitation estimating a pulmonary artery systolic pressure of 57mmHg, moderately reduced left ventricular ejection fraction (38%) and mild pericardial effusion close the right atrium.
case_images: Parasternal long-axis view echocardiography revealing severe concentric left ventricular hypertrophy (posterior wall 19 mm), thickened interventricular septum (interventricular septum 17 mm), and atrioventricular valves. . A = interventricular septum; B = posterior wall
case_images: cureus-0015-00000033364-i03.jpg
case_images: PMC9897811_01_cureus-0015-00000033364-i03.jpg
case_images: FIG3
case_images: Transthoracic echocardiogram (TEE) revealed the presence of a restrictive/infiltrative cardiomyopathy, showing grade III diastolic dysfunction (Figure 2), concentric severe left ventricular hypertrophy and right ventricular hypertrophy, severe right and left atrial enlargement, thickened heart valves (Figure 3) and interatrial septum, moderate tricuspid regurgitation estimating a pulmonary artery systolic pressure of 57mmHg, moderately reduced left ventricular ejection fraction (38%) and mild pericardial effusion close the right atrium.
case_images: Bull's eye graph of the left ventricle displacing the magnitude and homogeneity of longitudinal strain in color code map. It shows relative preservation of longitudinal strain at the apex resulting in a "cherry on top"/"apical sparing" pattern.
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case_images: PMC9897811_01_cureus-0015-00000033364-i04.jpg
case_images: FIG4
case_images: Scintigraphy with 99m-Technetium labeled 3,3-diphosphono-1,2-propano-dicarboxylic acid (DPD) showing myocardial uptake greater than bone with reduced/absent bone uptake - Perugini grade 3.
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case_images: PMC9897811_01_cureus-0015-00000033364-i05.jpg
case_images: FIG5
case_images: Radionuclide scintigraphy with 99m-Technetium labeled 3,3-diphosphono-1,2-propano-dicarboxylic acid (DPD) revealed a myocardial uptake greater than bone with reduced bone uptake - grade 3 (Figure 5).