Macroglossia and dyspnoea: precursor for cardiac amyloidosis
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The present case has been reported in BMJ. A 58-year-old man presented with a chief complaint of tongue indentations and discomfort. Otolaryngology treated him for oral thrush with counselling to avoid tongue biting. In addition, the patient reported dyspnoea described as a decrease in tolerance of his physical activities.

Due to continued increase in tongue size and worsening dyspnoea, he underwent a tissue biopsy with findings consistent with amyloidosis. Further evaluation with a bone marrow biopsy revealed underlying multiple myeloma.

Echocardiography revealed abnormal ventricular wall thickness, with a reduced left ventricular chamber size, dilated atria and Doppler findings with restrictive filling patterns indicative of cardiac amyloidosis. The patient was initiated on chemotherapy for his multiple myeloma and supportive therapy for his cardiac amyloidosis.

Learning points
• Any patient with overt macroglossia or lateral tongue indentation with or without associated periorbital bruise or plaque and symptoms of dyspnoea should be evaluated for AL cardiac amyloidosis.

• Cardiac amyloidosis with overt heart failure symptoms carries poor prognosis but the earlier it is diagnosed and treated, the better their prognosis.

• Identifying the precursor amyloid protein in amyloidosis is important because disease course and therapy differ among different forms of amyloid.

• Discrepancy observed on low voltage ECG with associated ventricular wall thickness on echocardiogram is highly suspicious for cardiac amyloidosis.

• Prophylactic cardiac defibrillator is not indicated in AL cardiac amyloidosis.

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Dr. R●●●●h V●●●●●●a
Dr. R●●●●h V●●●●●●a Interventional Cardiology
Cardiac amyloid , target sign on strain
Jan 8, 2019Like1