Issue 5/2026
Savova, R., Kinova, E., Borizanova, A., Somleva, D., Krastev, B., Markov, D., Gudev, A.
Department of Cardiology, University Hospital “Tsaritsa Yoanna – ISUL” – Sofia
Department of Emergency Medicine, Medical University – Sofia
Cardiac amyloidosis (CA) is a form of infiltrative cardiomyopathy that results in restrictive physiology from the myocardial deposition of misfolded protein deposits, known as amyloid fibrils, causing a clinically heterogeneous spectrum of systemic diseases. Despite the availability of modern disease-specific therapies and improved access to non-invasive diagnostic modalities, the diagnostic delay in patients with CA remains over 2 years. This is attributed to several factors, including the relative rarity of the disease and its clinical overlap with more common conditions that cause left ventricular hypertrophy. We present a clinical case of a 91-year-old male patient who presented with mild decompensation of known chronic congestive heart failure with preserved ejection fraction (HFpEF), NYHA functional class III. Following further diagnostic evaluation, a diagnosis of wild-type transthyretin amyloidosis was established. Bone scintigraphy and hematological testing for exclusion of AL amyloidosis are essential in establishing the diagnosis of ATTR cardiomyopathy.
Key words: cardiac amyloidosis, transthyretin amyloidosis, light-chain (AL) amyloidosis, transthyretin cardiomyopathy (ATTR-CM), left ventricular hypertrophy, heart failure
Adress for correspondence:
Dr. Rumena Savova
Department of Cardiology,
University Hospital “Tsaritsa Yoanna – ISUL”, Sofia
8, „Bjlo more“, Str.
1527, Sofia
e-mail: rumenasavova@gmail.com