trifascicular block as primary presentation of the cardiac amyloidosis; a rare case report

Background: amyloidosis is a severe systemic disorder produces by the accumulation of inappropriately amyloid deposition in tissues. cardiac involvement, as a main type of amyloidosis, has a major impact on prognosis. we describe a biopsy-proven cardiac amyloidosis in an old man with unexpected presentation. case report: a 70-year-old man, with a complaint of severe weakness, lightheadedness, and lower limb paresthesia, was admitted to the emergency department. electrocardiography revealed right bundle branch block and trifascicular block. echocardiography study showed a moderately increased thickness of left ventricular wall with concentric pattern as well. laboratory investigations including serum and urine electrophoresis, and serum free light chain examination as immunofixation assay revealed that κ chains predominated over λ chains in a ratio of 3:2. our patient with final diagnosis of amyloid light-chain (al) amyloidosis underwent chemotherapy with melphalan combined with high-dose dexamethasone, cphpc and monoclonal antibodies for 2 weeks. conclusion: it shows that rapid diagnosis of al amyloidosis can enhance the prognosis. applying an optimal strategy for the treatment leads to effective therapy, too.