Amyloid Pseudoinfarction

Report:

Sinus rhythm 85/min

VEB

Small voltage in frontal leads

Old inferior and extensive anterior infarctions

Comment:

The extensive infarction is, of course, an ECG diagnosis. This case demonstrates the need for differential diagnosis even (or especially) when the answer looks obvious. The correct diagnosis of amyloidosis was only established by endomyocardial biopsy in Sydney.

The commonest ECG findings in cardiac amyloidosis are seen here: pseudoinfarction and low voltage in the limb leads. They were present in almost half of all cases in a large (127 patients) Mayo Clinic series18.

Below (Fig 12a) is another tracing, with frequent VEBs.

The patient failed to improve on a dobutamine infusion and died in progressive renal failure secondary to low cardiac output – invariably a one-way process in ICU.

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