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Case report
Cardiac amyloidosis presenting with recurrent ischaemic strokes
  1. Suleiman Suleiman1,
  2. John Joseph Coughlan2 and
  3. David Moore1
  1. 1Department of Cardiology, Tallaght University Hospital, Dublin, Ireland
  2. 2Department of Cardiology, University Hospital Limerick, Limerick, Ireland
  1. Correspondence to Dr Suleiman Suleiman; suleimas{at}tcd.ie

Abstract

A 72-year-old man presented to our service with sudden onset right-sided weakness, aphasia and gaze palsy with diplopia. CT angiogram demonstrated an acute thrombotic occlusion of the distal basilar artery, a basilar infarct and the patient underwent successful thrombectomy. ECG and telemetry demonstrated slow atrial fibrillation (AF). His transthoracic echocardiogram (TTE) showed a reduced ejection fraction of 25% with global hypo-kinesis, a dilated left ventricle (LV) and LV hypertrophy (LVH). Repeat TTE appeared suspicious for an infiltrative cardiomyopathy with LVH and a speckled appearance to the myocardium. Approximately 10 months later, he suffered another ischaemic stroke post-elective cardioversion for AF while on anticoagulation. Cardiac MRI demonstrated areas of delayed gadolinium enhancement consistent with amyloidosis. Fat pad biopsy was positive for amyloidosis. Our patient has made an excellent recovery from the ischaemic strokes and is being managed in our heart failure clinic.

  • cardiovascular medicine
  • arrhythmias
  • heart failure
  • stroke
  • haematology (incl blood transfusion)
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Footnotes

  • Twitter @jjcoughl

  • Contributors SS: main author; abstract, introduction, literature review and discussion. JJC: coauthor; review of images and review of case report. DM: supervisor.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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