There are no established guidelines for the management of concurrent ischemic
cardiomyopathy and cardiac
amyloidosis due to the rarity of this phenomenon. We present the case of an African American woman in her 70s who was found to be in acute decompensated
heart failure after she presented with progressive
dyspnea. Initial workup revealed severe
left ventricular systolic dysfunction with an ejection fraction of 20% and severe multivessel
coronary artery disease, including severe
left main disease. Multimodality imaging with cardiac MRI and technetium-99m
pyrophosphate scintigraphy (PYP) during this hospital course revealed concurrent cardiac
amyloidosis. Her systolic dysfunction was attributed to a combination of cardiac
amyloidosis and ischemic
cardiomyopathy. A multidisciplinary team comprised of interventional cardiology, cardiac surgery, and advanced
heart failure amyloid specialists worked collaboratively to formulate an optimal treatment plan based on their collective clinical experiences and the limited literature, which ultimately resulted in a positive clinical outcome. Further investigation is needed to define treatment strategies specific to this patient population.