Cardiac amyloidosis

• Fatigue
• Dyspnea
• Dizziness
• Orthopnea
• Peripheral edema
• Weight loss due to cardiac cachexia
• Ascites
• Syncope on exertion
• Transthyretin (TTR) associated more common in African-Americans during sixth to seventh decade of life

• Elevated jugular pressure

Periorbital purpura: Often occurs with sneezing, coughing or with minor trauma. Indicates capillary involvement of AL type amyloidosis.

• Macroglossia

• Abnormal phonation
• Hepatomegaly
• Ascites may be present in the setting of heart failure
• Valvular involvement murmurs of mitral and tricuspid regurgitation (systolic).
  

• Normocytic mormochromic anemia
• Serum free-light-chain assay positive
• Increased BNP, ANP and β2 microglobulin
• Voltage-to-mass ratio is more sensitive than EKG, 2D Echo and nuclear scanning alone

• Granular or sparkling appearance of the left ventricular (LV) myocardium
• Increased left and right atrial volumes and reduced atrial function on cardiac MRI
• Atrial septal thickening
• Dynamic LV flow
• Mildly or moderately increased wall thickness in the early asymptomatic phase and severe thickening and hypokinesia of the left ventricular posterior wall and interventricular septum

ST Segment Elevation Myocardial Infarction

• Chest pain with possible radiation to left arm and lower jaw
• Squeezing, crushing chest pain
• Sweating
• Nausea and vomiting

• Anxious patient in pain with diaphoresis
• Signs of heart failure may be present
• Arrhythmia

• ST elevation, new left bundle branch block, and Q wave on EKG
• Elevated cardiac biomarkers

• Either complete or subtotal occlusion of an epicardial coronary artery on coronary angiography
• Confluent hyperenhancement extending from the endocardium

Non ST Elevation Myocardial Infarction

• Crushing, left-sided substernal chest pain or pressure that radiates to the neck or left arm

• Same as ST-elevation MI

• ST-segment depression or T-wave inversion on EKG
• Elevated cardiac biomarkers

Pericarditis

• Chest pain relieved by sitting up and leaning forward and worsened by lying down
• Fever, anxiety, difficulty breathing

• Pericardial friction rub
• Signs of cardiac tamponade may be present

• PR segment depression and electrical alternans on EKG

• A flask-shaped, enlarged cardiac silhouette on CXR
• Pericardial thickness of more than 4 mm on MRI
• Pericardial effusion and cardiac chamber indentation or collapse on echo when cardiac tamponade is present

Alcoholic Cardiomyopathy

• History of alcohol abuse
• Fatigue, weakness, anorexia, palpitations, and shortness of breath on activity
• Leg swelling and pedal edema

• Signs of heart failure such as presence of S3 and S4 heart sounds, pedal edema, and jugular venous distension
• Signs of alcoholic liver disease may be present

• Elevated MCV and MCHC on CBC
• Elevated LDH, AST, ALT, creatine kinase, gammaglutamyl transpeptidase, malic dehydrogenase, and alpha-hydroxybutyric dehydrogenase
• Q waves and non specific ST and T wave changes on EKG

• Cardiomegaly, pulmonary congestion, and pleural effusions on CXR
• Left ventricular dilatation on echo