title: A systemic disease un…suspected by physical examination.
abstract: A 73-year-old man was admitted to the cardiology department with unstable angina. He had a history of macroglossia with 3 years of development, attributed to hypothyroidism. On physical examination, he presented an exuberant macroglossia. The following diagnostic procedures were performed-ECG, in sinus rhythm with low voltage criteria, and transthoracic echocardiography, which revealed a left ventricle with preserved function and marked wall thickening, with low strain values in basal segments. The coronary angiography confirmed a lesion of 90% in the right coronary artery, treated with two stents. Suspecting a systemic infiltrative disease, additional tests were performed and these revealed the presence of systemic amyloid light-chain (AL) amyloidosis with cardiac involvement, associated with multiple myeloma. The patient was sent to a consult of haematology to begin chemotherapy.
authors.affiliation: Hospital Santarém, Santarém, Portugal.
authors.forename: Cátia
authors.initials: C
authors.lastname: Costa
authors.affiliation: Hospital Santarém, Santarém, Portugal.
authors.forename: Davide
authors.initials: D
authors.lastname: Severino
authors.affiliation: Hospital Santarém, Santarém, Portugal.
authors.forename: Maria Luz
authors.initials: ML
authors.lastname: Pitta
authors.affiliation: Hospital Santarém, Santarém, Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Leal
mesh_terms: D000368:Aged; D000682:Amyloid / Q000378:metabolism; D000686:Amyloidosis / Q000175:diagnosis* / Q000209:etiology; D000789:Angina, Unstable / Q000175:diagnosis* / Q000209:etiology; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology; D004452:Echocardiography; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D000075363:Immunoglobulin Light-chain Amyloidosis; D008297:Male; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D010808:Physical Examination; D014059:Tongue
chemical_list: D000682:Amyloid