Systemic Amyloidosis Presenting with Angina Pectoris

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Abstract
Manifestations of cardiac amyloidosis may include congestive heart failure and sudden cardiac death. Although vascular involvement in patients with amyloidosis is common, systemic amyloidosis presenting with angina is rare. To report on patients with systemic amyloidosis presenting with angina pectoris. Case series. Academic medical center. Five patients who presented with angina pectoris and normal coronary angiogram as the initial manifestation of systemic amyloidosis. Endothelial-dependent and endothelialindependent coronary flow reserve. All patients had coronary flow reserve abnormalities and subsequently developed congestive heart failure and systemic manifestations of amyloidosis. Histologic evaluation revealed amyloid deposition in the intramyocardial coronary vessels. Cardiac amyloidosis can present as angina pectoris associated with coronary flow reserve abnormalities despite normal coronary angiograms. This finding may have major therapeutic and prognostic implications in this patient population.

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