title: Primary systemic amyloidosis presenting as angina pectoris due to intramyocardial coronary artery involvement: a case report.
abstract: We describe a 76-year-old Japanese woman with primary systemic amyloidosis who presented with angina pectoris associated with ST-segment and T-wave abnormalities resulting from intramyocardial coronary artery amyloidosis. The patient was admitted to our hospital because of dyspnea and pretibial edema 7 years after the diagnosis of variant angina. A diagnosis of primary systemic amyloidosis (AL amyloid protein) was made after examination of gastric and endomyocardial biopsy specimens. The patient died of progressive, uncontrolled heart failure 3 months later. An autopsy study demonstrated only mild-to-moderate atherosclerosis in the epicardial coronary arteries. However, histological examination of the heart revealed diffuse stenoses and obstructions in the intramural coronary arteries by amyloid deposits. This patient had small-vessel coronary disease with ST-segment changes and angina caused by cardiac amyloidosis. A correct diagnosis of ischemic heart disease due to primary amyloidosis is important for estimation of the prognosis and for appropriate management.
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Yamano
authors.forename: Kotomi
authors.initials: K
authors.lastname: Motomiya
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Akai
authors.forename: Hideo
authors.initials: H
authors.lastname: Shiiki
authors.forename: Takayuki
authors.initials: T
authors.lastname: Toyama
authors.forename: Toshio
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Shinichi
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Shinobu
authors.initials: S
authors.lastname: Nakamura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Fukuoka
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000150:complications* / Q000175:diagnosis*; D000787:Angina Pectoris / Q000175:diagnosis* / Q000209:etiology*; D001158:Arteries / Q000473:pathology; D001344:Autopsy; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis*; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis*; D003331:Coronary Vessels / Q000473:pathology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D009206:Myocardium / Q000473:pathology