Clinical Snapshot

Persistent Retrosternal Pain in a 72-Year-Old Woman

Dtsch Arztebl Int 2017; 114(46): 792; DOI: 10.3238/arztebl.2017.0792

Bott-Flügel, L

Echocardiography, parasternal longitudinal axis, moderately severe left ventricular myocardial hypertrophy (arrows)
Figure 1
Echocardiography, parasternal longitudinal axis, moderately severe left ventricular myocardial hypertrophy (arrows)

A 72-year-old woman presented to the emergency department with chest pain, bilateral pedal edema, weight loss of 4 kg in the past 4 months, reflux symptoms, anorexia, a normal heart rate (70/min), and a low arterial blood pressure. Her laboratory values on admission were notable for elevated levels of BNP, troponin, D-dimers (3.6 µg/mL), and creatinine (1.4 mg/dL), as well as hypoproteinemia (6 g/dL), hypoalbuminemia (2.6 g/dL), and marked proteinuria (7 g/d). A chest x-ray revealed nonspecific degenerative bone changes. The retrosternal pain and the very high troponin-T value (0.195 ng/mL [<0.014]) suggested an acute coronary syndrome, prompting coronary angiography; this, however, ruled out coronary artery disease. She developed a contrast-induced nephrotic syndrome and myocardial hypertrophy. Serum and urinary electrophoresis studies and mucosal biopsies of the stomach and rectum were obtained. Bence-Jones proteins and a monoclonal gammopathy of the IgG light chain kappa type were found and a secondary amyloidosis of type AL was diagnosed. Bone marrow biopsy revealed multiple myeloma as the cause.
The patient died shortly after the diagnosis was made because of progressive left-heart failure and renal failure necessitating dialysis.

Dr. med. Dr. PH Heribert Ludwig Stich, MPH, Landratsamt Erding, stich.heribert@lra-ed.de

PD Dr. med. Lorenz Bott-Flügel, Klinikum Landkreis Erding

Conflict of interest statement: The authors state that they have no conflict of interest.

Cite this as: Stich HL, Bott-Flügel L: Persistent retrosternal pain in a 72-year-old woman. Dtsch Arztebl Int 2017; 114: 792. DOI: 10.3238/arztebl.2017.0792

Echocardiography, parasternal longitudinal axis, moderately severe left ventricular myocardial hypertrophy (arrows)
Figure 1
Echocardiography, parasternal longitudinal axis, moderately severe left ventricular myocardial hypertrophy (arrows)

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