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A 38-year-old man with an initial incidental finding of hypertension and proteinuria progressed to dyspnoea and hypotension within 4 months. Transthoracic echocardiography showed hypertrophic cardiomyopathy with a pathognomonic granular appearance of the myocardium and left ventricular ejection fraction (LVEF) of 35% (figure 1A). There was multiorgan involvement with cardiac MR and endomyocardial biopsy confirming the diagnosis of cardiac AL amyloidosis (figure 1B …
Competing interests None.
Provenance and peer review Not commissioned; not externally peer reviewed.