Cardiogenic Shock Patient Found to Have Cardiac Amyloidosis and Concurrent Multiple Myeloma.

backgroundCardiac amyloidosis is an under-recognized cause of heart failure. CASE SUMMARY: A 61-year-old man presented with acute decompensated heart failure and cardiogenic shock requiring peripheral venoarterial extracorporeal membrane oxygenation support. Endomyocardial biopsy revealed a diagnosis of light-chain cardiac amyloidosis. Work-up for incidentally noted hypercalcemia also revealed a rare diagnosis of concurrent multiple myeloma. Unfortunately, the patient clinically deteriorated with limited treatment options and ultimately died in hospital. DISCUSSION: We discuss this case in relation to the complexities of recognizing and making a diagnosis of cardiac amyloidosis as well as the atypical presentation with cardiogenic shock and concurrent multiple myeloma. TAKE-HOME MESSAGES: A broad differential diagnosis is required in patients with heart failure and worsening cardiogenic shock, including under-recognized etiologies such as cardiac amyloidosis. Though rare, cardiac amyloidosis can co-occur with multiple myeloma, and making the diagnosis early is important to inform available treatment options.