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Abstract
We present the case of a 53-year-old woman with New York Heart Association (NYHA) class III heart failure, despite optimal pharmacological therapy. Her medical history included: myocardial infarction with nonobstructive coronary arteries (MINOCA), heart failure with reduced ejection fraction and quadrantanopia with sensory neuropathy diagnosed as ischaemic stroke. Transthoracic echocardiography showed significant left ventricular hypertrophy with a ‘granular’ myocardial texture, global systolic dysfunction and restrictive mitral filling pattern. Two-dimensional (2D) transthoracic echo strain analysis demonstrated decreased global longitudinal strain with apical sparing, and helped to fit all the pieces of the jigsaw together to reach a consistent clinical diagnosis of cardiac amyloidosis.
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