Cardiac amyloidosis showing severe impairment of coronary flow reserve and left atrial function in a 75-year-old woman
whose transthoracic echocardiogram showed markedly concentric hypertrophy of the left ventricle and the typical “granular
sparkling” quality of the myocardium is described here. Transesophageal pulsed Doppler echocardiographic examination showed
a restrictive transmitral inflow velocity pattern and marked reduction in flow velocity during atrial systole sampled at the orifice
of the left upper pulmonary vein and the left atrial appendage, suggesting left atrial dysfunction. Transesophageal echocardiography also showed thickening of the interatrial septum. In addition, coronary flow reserve (ratio of peak hyperemic
to resting coronary blood flow velocity), measured by placing a Doppler guide wire in the left anterior descending artery and
administering intracoronary ATP, was severely impaired. Infiltration of the atria and small intramural arteries with amyloid
may explain the observed impairment of left atrial function and coronary flow reserve.