66 | Letters to the Editor International Cardiovascular Forum Journal 6 (2016) DOI: 10.17987/icfj.v6i0.174 Amyloid Cardiomyopathy: All that Sparkles is Amyloid Abhinav Saxena, Sameer Chadha, On Chen, Adnan Sadiq, Jacob Shani Address for correspondence: Abhinav Saxena Maimonides Medical Center, Brooklyn, NY 1016 50th street #1E Brooklyn, NY, 11219, USA Email: abhinavsaxenamd@gmail.com A 73 year old female with no past medical history presented to our emergency department (ED) with gradually worsening shortness of breath for a few weeks. She denied any associated complaints of chest pain, palpitations or dizziness. On physical exam, the patient had bilateral rales at the lung bases. The electrocardiogram showed low voltage complexes with right bundle branch block and left anterior fascicular block (Figure 1). The laboratory work came back signifcant for an elevated BNP (1452 pg/ml) with a normal complete blood count, serum chemistry and negative cardiac biomarkers. The patient was treated with intravenous diuretics in the ED and admitted to a telemetry foor. The echocardiogram performed on admission revealed concentric bi-ventricular hypertrophy resulting in a restrictive pattern and highly echogenic myocardium with ‘sparkling appearance’, suggestive of Cardiac Amyloidosis (fgure 2, Video 1, 2, see supplementary material on website). The LV systolic function was moderately decreased with global hypokinesis and there was bilateral atrial enlargement along with thickening of valve leafets and inter-atrial septum. A Cardiac MRI also showed delayed nodular enhancement of the myocardium indicative of an infltrative cardiomyopathy. Patient underwent an abdominal wall fat pad biopsy which came positive for light-chain Amyloidosis. Amyloid Cardiomyopathy is characterized by ventricular thickening due to amyloid deposition leading to diastolic dysfunction. It most commonly manifests with heart failure, conduction abnormalities or exertional syncope due to inability to augment cardiac output. The combination of increased ventricular mass on echocardiogram and reduced electrocardiographic voltages, along with granular appearance of the myocardium is highly suggestive of Amyloid Cardiomyopathy 1 . The diagnosis can be confrmed by demonstrating amyloid deposits on histologic examination of tissues from abdominal fat pad or kidney in patients with appropriate cardiac fndings.Cardiac amyloidosis should be considered in any adult with unexplained heart failure and an echocardiogram showing increased wall thickness with a non-dilated left ventricular cavity, particularly when associated with low voltage on electrocardiogram. Declarations of Interest The authors declare no conficts of interest Acknowledgements The authors agree to abide by the requirements of the statement of publishing ethics of the International Cardiovascular Forum Journal 2 . References 1. Falk RH. Diagnosis and management of the cardiac amyloidoses. Circulation 2005;112(13):2047-60. 2. Shewan LG, Coats AJS, Henein M. Requirements for ethical publishing in biomedical journals. International Cardiovascular Forum Journal 2015;2:2 DOI: 10.17987/icfj.v2i1.4 * Corresponding author. abhinavsaxenamd@gmail.com Keywords: Cardiac amyloidosis, amyloid cardiomyopathy Citation: Saxena A, Chadha S, Chen O, Sadiq A, Shani J. Amyloid Cardiomyopathy: All that sparkles is Amyloid. International Cardiovascular Forum Journal. 2016;6:66 DOI: 10.17987/icfj.v6i0.174 Figure 2. Add The echocardiogram. Figure 1. The ECG ISSN: 2410-2636 © Barcaray Publishing