title: Systemic amyloidosis presenting with angina pectoris.
abstract: 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.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
authors.forename: J
authors.initials: J
authors.lastname: Al Suwaidi
authors.forename: J L
authors.initials: JL
authors.lastname: Velianou
authors.forename: M A
authors.initials: MA
authors.lastname: Gertz
authors.forename: R O
authors.initials: RO
authors.lastname: Cannon
authors.forename: S T
authors.initials: ST
authors.lastname: Higano
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
authors.forename: A
authors.initials: A
authors.lastname: Lerman
mesh_terms: 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