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A 59-year-old man presented with chest pain and single-vessel coronary disease on angiography. Left ventricular function was normal with mild hypertrophy. He was treated for coronary disease but represented 18 months later with biventricular heart failure. There had been a striking ECG evolution: ST-segment change; reduced QRS amplitude; increased P-wave width and amplitude; and progressive increase in PR interval (196–276 ms) (Panel A). Echocardiography now …

Atrial pathology in cardiac amyloidosis: evidence from ECG and cardiovascular magnetic resonance