Document Detail

Symptomatic ischemic heart disease resulting from obstructive intramural coronary amyloidosis.
MedLine Citation:
PMID:  10974179     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Obstructive intramural coronary amyloidosis is an unusual complication of systemic amyloidosis. SUBJECTS AND METHODS: We review the characteristics of 11 patients seen at the Mayo Clinic (Rochester, Minnesota) from January 1, 1960, to June 1, 1999, with intramural cardiac amyloidosis diagnosed at autopsy or after examination of an explanted heart. RESULTS: Symptomatic ischemic heart disease resulting from obstructive intramural coronary amyloidosis was found in 11 patients (8 men, 3 women). The mean (+/-SD) age at the diagnosis of primary amyloidosis was 62 +/- 12 years. All patients had angina pectoris; angina was the presenting symptom of primary amyloidosis in 6 patients. Unstable coronary syndromes occurred in 7 patients and congestive heart failure in 8. New electrocardiographic abnormalities after the development of angina were common and included ischemic changes, bundle branch block, and dysrhythmias. Low voltage was seen in only 2 patients. All 7 patients who underwent coronary angiography had normal or clinically insignificant findings. Endomyocardial biopsy was performed on 4 patients; amyloid was found in 3 patients, none of whom had obstructive intramural coronary amyloidosis. The diagnosis of obstructive intramural coronary amyloidosis with associated myocardial injury was established only at autopsy or after examination of the explanted heart after cardiac transplantation. The mean time to death or cardiac transplantation after symptoms of cardiac ischemia developed was 18 +/- 20 months. CONCLUSIONS: The diagnosis of ischemic heart disease resulting from obstructive intramural coronary amyloidosis is difficult to establish before death or cardiac transplantation. Although the condition has a poor prognosis, its accurate recognition may have therapeutic implications, because some patients may benefit from treatment, including systemic chemotherapy or cardiac transplantation.
P S Mueller; W D Edwards; M A Gertz
Related Documents :
4053429 - Cardiac amyloidosis: combined use of two-dimensional echocardiography and electrocardio...
10898439 - Echocardiographic findings in fulminant and acute myocarditis.
19188779 - Cardiac involvement after respiratory tract viral infection--detection by cardiac magne...
11922029 - Tuberculosis myocarditis: a case report.
667859 - Invasive and noninvasive methods of assessing adriamycin cardiotoxic effects in man: su...
8780929 - The myocardial fibrosis in patients with dilated cardiomyopathy. the application of ima...
20920659 - Relation of cardiac ventricular repolarization and global cognitive performance in a co...
21587139 - A modified infarct exclusion repair of posterior postinfarction ventricular perforation...
11257079 - Bone formation and inflammation in cardiac valves.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  109     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  2000 Aug 
Date Detail:
Created Date:  2000-10-05     Completed Date:  2000-10-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  181-8     Citation Subset:  AIM; IM    
Division of General Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Aged, 80 and over
Amyloidosis / complications*,  diagnosis*,  mortality,  pathology
Cardiomyopathies / complications*,  diagnosis*,  mortality,  pathology
Constriction, Pathologic / complications,  etiology
Coronary Angiography
Middle Aged
Myocardial Ischemia / etiology*,  mortality
Retrospective Studies
Survival Analysis
Comment In:
Am J Med. 2000 Aug 15;109(3):249   [PMID:  10974191 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Diffusion and fate of intramuscularly injected human rabies immune globulin.
Next Document:  Realizing the potential of clinical judgment: a real-time strategy for predicting outcomes and cost ...