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Strange case of biventricular heart failure
  1. Carloalberto Biolè1,
  2. Matteo Bianco1,
  3. Antonella Parente2 and
  4. Laura Montagna1
  1. 1Department of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
  2. 2Department of Nuclear Medicine, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
  1. Correspondence to Dr Matteo Bianco; matteo.bianco87{at}


Acute heart failure (HF) is commonly caused by a cardiomyopathy with one or more precipitating factor. Here, a case in which a cardiomyopathy is precipitated by pulmonary embolism (PE). A 77-year-old man is admitted for breathlessness and leg swelling. A mild reduction of left ventricular (LV) ejection fraction is found, with moderately increased LV wall thickness and pulmonary hypertension; clinical examination revealed signs of congestion with bilateral leg swelling, and mild signs of left HF with the absence of pulmonary congestion on chest X-ray. The ECG showed Mobitz I second-degree atrioventricular block. The clinical scenario led us to the diagnosis of infiltrative cardiomyopathy due to cardiac amyloidosis (CA) precipitated by PE. Pulmonary embolism is an overlooked precipitant of HF and can be the first manifestation of an underlying misdiagnosed cardiomyopathy, especially CA. 3,3-Diphosphono-1,2-propanodicarboxylic acid scan is a cornerstone in the diagnosis of Transthyretin amyloidosis (ATTR) cardiac amyloidosis.

  • heart failure
  • venous thromboembolism

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  • Contributors CB and Dr MB managed the patient, wrote a review of the case report. AP performed the DPD scan and reviewed the manuscript. LM managed the patients and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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