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Previous Volume 357:2286-2297 November 29, 2007 Number 22 Next

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Presentation of Case

Four weeks after he received a heart transplant, a 47-year-old man was admitted to this hospital because of ventricular dysfunction detected on echocardiography. The patient had been well until 19 months earlier, when congestive heart failure developed, followed by several syncopal episodes. Echocardiography performed at another hospital revealed a speckled pattern of reflectance of the ventricular myocardium, and pathological examination of a biopsy specimen of a fat pad obtained at that hospital was positive for the presence of amyloid. Examination of a bone marrow biopsy specimen revealed 10% plasma cells, and free lambda light chains were present in the serum.

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Differential Diagnosis

Primary Cardiac Amyloidosis

The Donor Heart

Early Decline in Cardiac Function after Transplantation

Transplant Rejection

Other Causes of Cardiac Dysfunction

Myocardial Infarction

            Causes of Myocardial Infarction in Allografts

            Timing of Myocardial Infarction in this Patient

Dr. Lynne Warner Stevenson's Diagnosis

Pathological Discussion

Anatomical Diagnoses

Source Information

From the Cardiology Division (M.J.S., J.J.P.) and the Department of Pathology (J.R.S.), Massachusetts General Hospital; the Cardiovascular Division, Brigham and Women's Hospital (L.W.S.); and the Departments of Medicine (M.J.S., L.W.S., J.J.P.) and Pathology (J.R.S.), Harvard Medical School.

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