'Green Apple' Heart Failure

Abstract

We report here the clinical case of an Afro-Caribbean patient referred for complete atrioventricular block for whom a diagnosis of hereditary cardiac amyloidosis was eventually confirmed. Hereditary cardiac amyloidosis is an emerging threat in the Caribbean, and the main goal of this report is to raise the awareness of the disease among physicians.

Figures

Fig. 1. Increased wall thickness contrasting with low QRS voltage, a very suggestive pattern of cardiac amyloidosis.

Fig. 2. Enhanced myocardial uptake of 99Tc-dicarboxypropane diphosphonate.

Fig. 3. Late subendocardial enhancement on magnetic resonance imaging.

Fig. 4. Amyloid deposition (*) in haematoxylin-eosin (A) and Congo red (B), with polarization (C), stained endomyocardial biopsy specimens.