Article: PDF OnlyThe Clinical Problem of Occult Cardiac Amyloidosis Forensic ImplicationsPetersen, Erik C.; Engel, Joshua A.; Radio, Stanley J. M.D.; Canfield, Thomas M. M.D.; McManus, Bruce M. M.D., Ph.D.Author Information From the Cardiovascular Registry (E.C.P., J.A.E., S.J.R., B.M.M.), Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska; and the Office of Medical Investigation (T.M.C.), Montrose County, Montrose, Colorado. The American Journal of Forensic Medicine and Pathology: September 1992 - Volume 13 - Issue 3 - p 225-229 Buy Abstract A 68-year-old man with known coronary heart disease experienced rapidly progressive cardiac dysfunction and was found to have occult cardiac amyloidosis at autopsy. The amyloidosis was undiagnosed during life and initially at autopsy. Marked diffuse involvement of the intramural coronary arteries by amyloid deposits resulted in severe luminal compromise of numerous medium and small vessels. The myocardium proper was virtually spared from amyloid deposits. Amyloid-related coronary narrowing contributed to cardiac ischemia and sudden death. The significance of amyloid coronary disease in this patient relates primarily to the difficulty in considering the diagnosis when other reasons for cardiac signs and symptoms preexist. Also, the adverse effects of amyloid coronary disease may be profound without direct myocardial involvement. © Lippincott-Raven Publishers.