Dizziness and amyloidosis in prehospital.

68 years old male referring dizziness and lighthead. Denies chest pain.

Pale cold sweating is laying on bed. Chest and abdominal examination are negative. Cardiac examination reveals arrithmiyc tones and free pauses. No smoking no diabetes.

His past history is positive for cardiac amyloidos  (proteinuria Bence Jones k)  triple A surgically corrected many years ago. Hypertension and AFib farmacologiccally cardioverted 1 year ago.  He is in treatment with Propafenone 150×4, Ramipril and Warfarin. No smoking no diabetes.

This morning ha did a routine control ECG and echo. All the parameters where fine. The documentation is not with him right now so is not possible a proper confrontation with the actual findings.

Vital signs:

BP is 70/50, satO2 room air 98%.

The 12 leads EKG is shown below

and a longer monitor recording….

Which are the EKG findings?

When the patient is invited to stand refers presyncopal signs and tends to faint. BP drops and the skin become pale and sweaty

Which is the racommended management?

Blood exams are normal except TnI tha is slightly elevated (0,23) and the INR is 3

Which is your diagnosis?

Tags: ecg, EKG case, elettrocardiografia, elettrocardiografy, emergency medicine, emergenza sanitaria territoriale, medicina d'urgenza, prehospital emergency medicine