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254 echocardiography. The amount of pericardial flu‐ id increased to 30 mm behind the posterior wall. On 24 ‐hour Holter monitoring, multiple episodes of atrial tachycardia and a short single ventricu‐ lar tachycardia were recorded. An estimated risk of sudden cardiac death (SCD) was 3.99%. Except for cardiovascular abnormalities, no other symp‐ toms were observed. Magnetic resonance imaging (CMR) was per‐ formed for further risk stratification. It showed heterogeneous edema with a perfusion disorder. The diagnostic workup was extended to include a myocardial biopsy. Histological staining of Con‐ go Red (FIGURE 1A), immunohistological evaluation (FIGURE 1B), and transmission electron microscopy (FIGURE 1C) showed amyloid deposits. The final diagnosis of cardiac amyloidosis was established, and the patient was transferred to a hematology department for further examina‐ tion and treatment. After bone marrow biopsy A 63 ‐year ‐old woman with a short history of or‐ thostatic fainting and heart palpitations was ad‐ mitted to the hospital for further diagnostic work‐ up. Preliminary diagnostic tests, including trans‐ thoracic echocardiography, were done in a local hospital. A gradual accumulation of pericardi‐ al effusion and granular ventricular septal effu‐ sion were observed. Buccal mucosal biopsy did not confirm the tentative diagnosis of cardiac amyloidosis. Physical examination on admission revealed severe dyspnea (New York Heart Association class III), sinus tachycardia (105 bpm), and hypo‐ tension (90/60 mm Hg). Laboratory tests showed high levels of N ‐terminal pro ‐B‐type natriuretic peptide, characteristic of heart failure. Left ven‐ tricular wall thickening, left atrial enlargement, nonhomogeneous intraperitoneum, mitral re‐ striction profile, and slightly reduced ejection fraction (45%) were observed on transthoracic CLINICAL IMAGE

Cardiac amyloidosis - myocardial biopsy as a tool in chemotherapy implementation and SCD prevention