Best Cases: Non-Ischemic Heart Disease-Spontaneous intramyocardial hemorrhage in a patient with transthyretin cardiac amyloidosis

Spontaneous intramyocardial hemorrhage in a patient with transthyretin cardiac amyloidosis

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Video Summary

A 72-year-old man undergoing SVT ablation was found to have severe left ventricular hypertrophy and, on cardiac MRI, spontaneous intramyocardial hemorrhage with extensive global late gadolinium enhancement consistent with transthyretin cardiac amyloidosis. Follow-up CMR at one week, one month, and two months showed progressive hematoma shrinkage and near-resolution. Workup supported wild-type ATTR amyloidosis: negative serum/urine electrophoresis, positive biopsy and PYP scan, and negative TTR gene testing. The case highlights a rare complication of amyloid-related vessel fragility and the value of serial CMR in tracking hemorrhage evolution.

Keywords

transthyretin cardiac amyloidosis

intramyocardial hemorrhage

cardiac MRI

wild-type ATTR amyloidosis

serial CMR follow-up