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Patient
74-year-old woman, followed for myeloma and referred for palpitations;
Trace
Different electrical signs are suggestive of the presence of cardiac amyloidosis; atrial fibrillation with slowed atrioventricular conduction in the absence of rate-controlling treatment (attesting to an atrioventricular conduction disorder); clearly low-voltage QRS in limb leads (< 5mm in all limb leads); voltage slightly more elevated in precordial leads although no lead with an amplitude > 10 mm; QRS axis deviated to the right (136°); pseudo q wave pattern (V1-V2) with poor anterior R wave progression;
Trace
Tracing recorded after performing an external electric shock; sinus rhythm, with long PR pattern (first degree AV block);
Exergue
In a patient with cardiac amyloidosis, it is common to observe various, electrocardiographic signs in discordance with the echocardiographic pattern: low voltage, pseudo-necrosis q waves, repolarization disorders, rhythm disturbances or conduction disorders.
This patient presented a myeloma complicated with AL-type cardiac amyloidosis with evocative electrical signs inconsistent with ultrasound ventricular hypertrophy. The electrocardiogram is abnormal in 90% of amyloidosis patients with cardiac involvement.