Trifascicular block as primary presentation of the cardiac amyloidosis; A rare case report
نویسندگان
1 Assistant Professor, Department of Emergency, Dey 9th Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
2 Department of Obstetrics and Gynecology, Dey 9th Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
3 Assistant Professor, Department of Cardiology, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
4 MSc Student, Student Research Committee AND Department of Cardiac Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
5 Assistant Professor, Department of Pharmacology, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
doi
10.22122/arya.v14i2.1676چکیده
BACKGROUND: Amyloidosis is a severe systemic disorder produces by the accumulation of inappropriately amyloid deposition in tissues. Cardiac involvement, as a main type of amyloidosis, has a major impact on prognosis. We describe a biopsy-proven cardiac amyloidosis in an old man with unexpected presentation.CASE REPORT: A 70-year-old man, with a complaint of severe weakness, lightheadedness, and lower limb paresthesia, was admitted to the emergency department. Electrocardiography revealed right bundle branch block and Trifascicular block. Echocardiography study showed a moderately increased thickness of left ventricular wall with concentric pattern as well. Laboratory investigations including serum and urine electrophoresis, and serum free light chain examination as immunofixation assay revealed that κ chains predominated over λ chains in a ratio of 3:2. Our patient with final diagnosis of amyloid light-chain (AL) amyloidosis underwent chemotherapy with melphalan combined with high-dose dexamethasone, CPHPC and monoclonal antibodies for 2 weeks.CONCLUSION: It shows that rapid diagnosis of AL amyloidosis can enhance the prognosis. Applying an optimal strategy for the treatment leads to effective therapy, too.
