"Two is Company, Three is a Crowd" - A Case Presentation of Cardiac Amyloidosis, Hypertrophic Cardiomyopathy Plus Coronary Heart Disease.

Abstract

A 76-year-old man was referred to our appointment with complaints of exertional dyspnea. He had a medical history consisting of chronic coronary syndrome, hypertrophic cardiomyopathy, and an implantable cardioverter-defibrillator for primary prevention. A transthoracic echocardiogram revealed features suspicious for cardiac amyloidosis. Haematologic and genetic tests were negative, and scintigraphy was positive, confirming wild-type transthyretin amyloidosis, not eligible for tafamidis. Several months later with optimized medical therapy, he had two worsening heart failure events. This clinical case highlights the importance of differential diagnosis. Our patient had both hypertrophic cardiomyopathy and transthyretin amyloidosis, a rare association that constitutes a diagnostic and treatment challenge.