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Imaging suggested cardiac amyloidosis, renal biopsy confirmed AL amyloidosis, and bone marrow biopsy showed multiple myeloma. Treatment was started but the patient died five months after diagnosis.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/silent-progression-cardiac-amyloidosis-unmasking-igg-lambda-myeloma-in-an-elderly-patient/453416/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/silent-progression-cardiac-amyloidosis-unmasking-igg-lambda-myeloma-in-an-elderly-patient/453416.png","ImageObject",300,407,{"name":42,"@type":43},"Ezra","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-04","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why is cardiac amyloidosis often missed in elderly patients with HFpEF?","Question",{"text":63,"@type":64},"Its clinical presentation is nonspecific and can mimic hypertensive heart disease or HFpEF. Delayed recognition is common, especially when cardiac symptoms precede hematologic findings.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What findings supported the diagnosis of cardiac amyloidosis in this case?",{"text":68,"@type":64},"Echocardiography and cardiac MRI showed concentric left ventricular hypertrophy with a “sparkling” myocardial texture, biatrial dilation, restrictive filling, and diffuse subendocardial late gadolinium enhancement. Laboratory tests also suggested a monoclonal process and myocardial injury.",{"name":70,"@type":61,"acceptedAnswer":71},"How was AL amyloidosis and multiple myeloma confirmed, and what was the outcome?",{"text":72,"@type":64},"Renal biopsy demonstrated amyloid deposits with Congo red positivity and light-chain (lambda) restriction, confirming AL amyloidosis. Bone marrow biopsy confirmed multiple myeloma. The patient received bortezomib-based chemotherapy and supportive care but died five months after diagnosis.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},453416,1791160927,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":102,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},1099514068035,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Touiti et al. The Egyptian Heart Journal (2026) 78:1  \n[https://doi.org/10.1186/s43044-026-00715-w](https://doi.org/10.1186/s43044-026-00715-w)  \nThe Egyptian Heart Journal  \nCASE REPORT Open Access  \nSilent progression: cardiac amyloidosis unmasking IgG lambda myeloma in an elderly patient  \nSoufianeTouiti1*, Meriem Bouali 1, Loubna El Bahri2, Iliyasse Asfalou2, Zouhair Lakhal1 and Aatif Benyass1,2  \nAbstract  \nBackground Cardiac amyloidosis is an underrecognized etiology of heart failure with preserved ejection fraction (HFpEF), particularly in elderly patients. Light-chain (AL) amyloidosis, when associated with multiple myeloma, is highly aggressive and portends a poor prognosis, especially in advanced cardiac stages.  \nCase presentation We report the case of a 79-year-old male with type 2 diabetes, hypertension, and a history of pacemaker implantation for complete atrioventricular block in the context of atrial fibrillation. He was admitted with progressive exertional dyspnea and an episode of syncope. Clinical examination revealed fine basal crackles and signs of decompensated heart failure. ECG demonstrated a paced rhythm. Echocardiography and cardiac MRI revealed concentric left ventricular hypertrophy with a sparkling myocardial texture, biatrial dilation, restrictive filling pattern, and diffuse subendocardial late gadolinium enhancement—features highly suggestive of cardiac amyloidosis. Laboratory tests revealed anemia, nephrotic syndrome, elevated troponin and NT-proBNP, and a monoclonal IgG lambda spike. Renal biopsy demonstrated amyloid deposits with Congo red positivity and light-chain (lambda) restriction, confirming the diagnosis of AL amyloidosis. Bone marrow biopsy confirmed the diagnosis of multiple myeloma with plasma cell infiltration. Based on clinical and laboratory findings, the patient was classified as Mayo stage IIIB AL cardiac amyloidosis and ISS stage I multiple myeloma. He received bortezomib-cyclophosphamidebased chemotherapy and supportive care, but unfortunately died five months after diagnosis.  \nDiscussion This case highlights the importance of early recognition of cardiac amyloidosis in elderly patients with unexplained heart failure and monoclonal gammopathy. Echocardiography plays a pivotal role in early disease suspicion, particularly in resource-limited settings, while cardiac MRI serves as a complementary tool for assessing myocardial involvement. Despite advances in treatment, outcomes remain poor in advanced cardiac involvement. Early intervention may improve prognosis, underscoring the need for heightened clinical awareness.  \nConclusion Infiltrative cardiomyopathies like AL amyloidosis should be considered in elderly patients with heart failure and systemic red flags. Timely diagnosis and multidisciplinary management are essential but often insufficient in advanced stages.  \n*Correspondence: SoufianeTouiti[s.touiti98@gmail.com](s.touiti98@gmail.com)  \nFull list of author information is available at the end of the article  \n© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/.)[.](http://creativecommons.org/licenses/by/4.0/.)  \nTouiti ","cbCaitk4ilSCVs6g","https://ap.wps.com/l/cbCaitk4ilSCVs6g","pdf",1142043,"English","# Case report\n## Background\n## Case presentation\n## Discussion\n## Conclusion\n# Keywords","[{\"question\":\"Why is cardiac amyloidosis often missed in elderly patients with HFpEF?\",\"answer\":\"Its clinical presentation is nonspecific and can mimic hypertensive heart disease or HFpEF. Delayed recognition is common, especially when cardiac symptoms precede hematologic findings.\"},{\"question\":\"What findings supported the diagnosis of cardiac amyloidosis in this case?\",\"answer\":\"Echocardiography and cardiac MRI showed concentric left ventricular hypertrophy with a “sparkling” myocardial texture, biatrial dilation, restrictive filling, and diffuse subendocardial late gadolinium enhancement. Laboratory tests also suggested a monoclonal process and myocardial injury.\"},{\"question\":\"How was AL amyloidosis and multiple myeloma confirmed, and what was the outcome?\",\"answer\":\"Renal biopsy demonstrated amyloid deposits with Congo red positivity and light-chain (lambda) restriction, confirming AL amyloidosis. Bone marrow biopsy confirmed multiple myeloma. The patient received bortezomib-based chemotherapy and supportive care but died five months after diagnosis.\"}]","Silent progression - cardiac amyloidosis unmasking IgG lambda myeloma in an elderly patient | PDF",1790738819,15]