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Implantation of a cardioverter-defibrillator in a patient with cardiac amyloidosis

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 110–114 (2006)Cite this article

Abstract

Background A 49-year-old woman presented with chest pain of 10 days' duration. Initial physical examinations and laboratory investigations were normal. The patient received symptomatic treatment with β-blockers, which continued following normal findings on coronary angiogram. About 7 months later the patient developed ventricular arrhythmias, with clinical evidence of left ventricular heart failure. Her arrhythmia symptoms persisted despite pharmacological therapy with atenolol, carvedilol and amiodarone.

Investigations Physical examination, electrocardiography, laboratory testing, serologic testing, exercise-tolerance testing, coronary angiography, chest radiography, cardiac MRI, tongue biopsy, bone-marrow biopsy, CT scan, iodine-123-labeled serum-amyloid-P-component scintigraphy.

Diagnosis Systemic primary amyloidosis (AL amyloidosis), with predominant cardiac involvement.

Management Pharmacological antiarrhythmic therapy and cardioverter-defibrillator implantation. Chemotherapy was planned but, despite intervention, the patient died before this treatment could begin.

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Figure 1: Initial electrocardiogram of the patient at presentation with no signs of cardiac dysfunction.
Figure 2: An electrocardiogram of the patient showing evidence of infiltration and pseudo-infarction, with anterolateral Q waves and small QRS complexes in the standard leads.

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Author information

Authors and Affiliations

  1. Cardiology,

    Ben LC Wright, Andrew A Grace & Hugh JB Goodman

  2. Papworth Hospital, Papworth Everard,

    Ben LC Wright, Andrew A Grace & Hugh JB Goodman

  3. National Amyloidosis Centre, Royal Free & University College Medical School, London, UK

    Ben LC Wright, Andrew A Grace & Hugh JB Goodman

Authors
  1. Ben LC Wright
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  2. Andrew A Grace
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  3. Hugh JB Goodman
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Corresponding author

Correspondence to Ben LC Wright.

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The authors declare no competing financial interests.

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Wright, B., Grace, A. & Goodman, H. Implantation of a cardioverter-defibrillator in a patient with cardiac amyloidosis. Nat Rev Cardiol 3, 110–114 (2006). https://doi.org/10.1038/ncpcardio0461

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  • DOI: https://doi.org/10.1038/ncpcardio0461

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