Systemic amyloidosis presenting with angina pectoris.
BACKGROUND
Manifestations of cardiac amyloidosis may include congestive heart failure and sudden cardiac death. Although vascular involvement in patients with amyloidosis is common, systemic amyloidosis presenting with angina is rare.


OBJECTIVE
To report on patients with systemic amyloidosis presenting with angina pectoris.


METHODS
Case series.


METHODS
Academic medical center.


METHODS
Five patients who presented with angina pectoris and normal coronary angiogram as the initial manifestation of systemic amyloidosis.


METHODS
Endothelial-dependent and endothelial-independent coronary flow reserve.


RESULTS
All patients had coronary flow reserve abnormalities and subsequently developed congestive heart failure and systemic manifestations of amyloidosis. Histologic evaluation revealed amyloid deposition in the intramyocardial coronary vessels.


CONCLUSIONS
Cardiac amyloidosis can present as angina pectoris associated with coronary flow reserve abnormalities despite normal coronary angiograms. This finding may have major therapeutic and prognostic implications in this patient population.
Al Suwaidi
J
J
Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
Velianou
J L
JL
Gertz
M A
MA
Cannon
R O
RO
Higano
S T
ST
Holmes
D R
DR
Lerman
A
A
D000368:Aged; D000686:Amyloidosis / Q000150:complications* / Q000473:pathology; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000209:etiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged