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A Patient with Cardiac Amyloidosis who Underwent Pacemaker Implantation for Sick Sinus Syndrome Yumi Shimura 1 , Ko Takeichi 1 , Naohide Tanaka 1 , Hitoshi Nagamatsu 1 , Hisayuki Okada 1 , Rie Sawai 1 , Yoshimi Ota 1 , Masahiko Aosaki 2 , Yasunari Sakomura 3 , Kazuyo Takeda 3 , Tosiro Nishikawa 3 1Department of Cardiology, National Yokohama Hospital 2Department of Clinical Research Institute, National Yokohama Hospital 3Second Department of Pathology, Tokyo Women's Medical College Keyword: 心アミロイドーシス , 洞不全症候群 , 恒久的ペースメーカ植え込み , cardiac amyloidosis , sick sinus syndrome , pacemaker implantation pp.505-509
Published Date 1998/5/15
DOI https://doi.org/10.11477/mf.1404901696
  • Abstract
  • Look Inside

A 60-year-old male was hospitalized due to exer-tional dvspnea. Chest X-ray revealed cardiac dilatation and retention of pleural effusion on the right side, sug-gesting heart failure. Electrocardiogram showed left axis deviation, ST-segment elevation in lead V1 through V3, and deep S wave in lead V4 through V6. Echocardio-graphy revealed myocardial thickening and retention of pericardial effusion. Cardiac catheter examination revealed normal for the left and right ventricular con-traction capacities, but the hemodynamics study showed a restrictive phenomenon. Myocardial biopsy showed the deposit of amyloid fiblil, so we diagnosed the patient to have cardiac amyloidosis. Diuretics and vasodilator agents were administered to treat heart failure, but resulting in no improvement. Concurrently sick sinus syndrome developed, resulting in exacerbation of heart failure. Shortly after temporary pacing was performed, pleural effusion disappeared, and heart function im-proved. A few days later, permanent pacemaker im-plantation was performed, and heart failure was suc-cessfully controlled. Cardiac amyloidosis is a progres-sive disease for which radical treatment has not yet been established. In the present case, VVI pacing was useful for controlling heart failure. However,the effect of VVI pacing may be transient, so further careful follow-up is necessary.


Copyright © 1998, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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