case_images: PMC8238623_01
case_images: Electrocardiogram on admission showing sinus rhythm with low voltage, prior infarct of anteroseptal regions, and T-wave inversions in lateral leads.
case_images: CRIM2021-3293728.001.jpg
case_images: PMC8238623_01_CRIM2021-3293728.001.jpg
case_images: fig1
case_images: Electrocardiogram revealed sinus rhythm with first-degree AV block, low voltage, old infarct with Q waves in anteroseptal leads, and T-wave inversions in anterolateral leads (Figure 1).
case_images: Echocardiography shows low global longitudinal cardiac strain (-13.4%) with "cherry on top" pattern (normal value for global longitudinal strain is -20% and below in healthy individuals). Strain pattern is suggestive of possible cardiac amyloidosis.
case_images: CRIM2021-3293728.002.jpg
case_images: PMC8238623_01_CRIM2021-3293728.002.jpg
case_images: fig2
case_images: III restrictive diastolic filling pattern suggestive of increased left atrial pressure, preserved ejection fracture (60-65%), dilated inferior vena cava with <50% respiratory variation, and severe concentric left ventricular hypertrophy concerning for infiltrative process per strain pattern (Figure 2). Interventricular septum was 1.5 cm (normal: 0.7-1.1 cm), and posterior wall thickness was 1.4 cm (normal: 0.7-1.1 cm).
case_images: Electrocardiogram after cardiac arrest with junctional bradycardia and premature ventricular complexes.
case_images: CRIM2021-3293728.003.jpg
case_images: PMC8238623_01_CRIM2021-3293728.003.jpg
case_images: fig3
case_images: On the day after admission, she developed unstable ventricular tachycardia but spontaneously converted after two minutes to junctional bradycardia (Figure 3).
case_images: Autopsy of cardiac muscle with increased subpericardial fat asymmetrically concentrated more towards the right ventricle compared to the left ventricle.
case_images: CRIM2021-3293728.004.jpg
case_images: PMC8238623_01_CRIM2021-3293728.004.jpg
case_images: fig4
case_images: They authorized the autopsy which subsequently revealed gross cardiomegaly and left ventricular hypertrophy (Figure 4).
case_images: (a) Infiltrative amyloid deposits noted among the myocytes on hematoxylin and eosin stain. (b) Congo red stain with apple-green birefringence within the right and left ventricle tissues.
case_images: CRIM2021-3293728.005.jpg
case_images: PMC8238623_01_CRIM2021-3293728.005.jpg
case_images: fig5
case_images: Congo red staining of both ventricular and hepatic tissue revealed amyloid fibrils with apple-green birefringence (Figure 5).