ROBERT CAPONE, M.D.; EZRA A. AMSTERDAM, M.D.; DEAN T. MASON, M.D., F.A.C.P.; ROBERT ZELIS, M.D.
A patient with orthostatic hypotension and congestive heart failure had primary amyloidosis. Study of autonomic function showed failure of both sympathetic and parasympathetic reflexes. Diffuse myocardial dysfunction was demonstrated by cardiac catheterization. Lactate production was detected despite arteriographically normal coronary arteries at rest and with isoproterenol stimulation. It is suggested that myocardial ischemia may be related to small-vessel infiltration by amyloid, diffusion block at the capillary level by amyloid, or myocardial hypertrophy. The therapeutic implications of balancing the need for an increased blood volume to compensate for the autonomic dysfunction against the need for a decreased preload in treatment of heart failure are discussed.
CAPONE R, AMSTERDAM EA, MASON DT, ZELIS R. Systemic Amyloidosis, Functional Coronary Insufficiency, and Autonomic Impairment. Ann Intern Med. ;76:599–603. doi: 10.7326/0003-4819-76-4-599
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Published: Ann Intern Med. 1972;76(4):599-603.
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