Medical Emergencies · patient case question
What does amyloid deposition in the myocardium produce?
Patient case: Bone pain, anemia and an enlarged tongue
Patient: 64-year-old man referred by his physician.
Chief complaint: His tongue feels too big for his mouth and he is exhausted.
History: Six months of back pain, fatigue and recurrent infections. Recent labs show anemia, hypercalcemia and elevated creatinine. Skull radiographs show multiple well-defined punched-out radiolucencies.
Findings: Enlarged tongue with lateral scalloping from tooth indentations. Pallor of the oral mucosa. Working diagnosis: multiple myeloma with systemic AL amyloidosis.
Show answer and explanation
Correct answer: D. A restrictive cardiomyopathy with impaired diastolic filling
- A. Dilated cardiomyopathy follows alcohol, viral myocarditis, or ischemia — the ventricle enlarges and contracts poorly, the opposite geometry.
- B. The walls look thickened on echocardiography, a pseudohypertrophy, but true HOCM is a genetic sarcomeric disorder with asymmetric septal hypertrophy and outflow obstruction.
- C. Amyloid affects the myocardium diffusely rather than producing isolated valve lesions.
- D. CORRECT. Amyloid infiltrates between myocytes and stiffens the ventricular wall. The heart cannot relax and fill, giving a RESTRICTIVE cardiomyopathy with diastolic dysfunction and, eventually, heart failure. This is the leading cause of death in AL amyloidosis.
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