Angina with a normal coronary angiogram caused by amyloidosis

Abstract

A case of severe intractable angina pectoris with normal angiography is presented. Following video assisted thoracic sympathectomy the patient died of heart failure. Microvascular cardiac amyloidosis was diagnosed at the postmortem examination. This report alerts clinicians to this possible diagnosis when treating patients with severe angina when no cause is found and discusses the poor prognosis in such cases.

Figures

Figure 1

Diffuse heavy deposits of Congo Red positive amyloid are seen in the intramyocardial coronary arteries; the epicardial mildly stenosed coronary artery branch (arrow) is itself free of amyloid. Inset shows green birefringence of vascular amyloid.