Right Ventricle Outflow Obstruction in Biventricular Hypertrophic Cardiomyopathy in Amyloidosis

Light-chain (AL) amyloidosis is the most common type of amyloidosis; cardiac involvement is rare but has a poor prognosis. Biventricular hypertrophic cardiomyopathy is an exceptional finding in amyloidosis and its association with obstructive right ventricular gradient is even rarer. We report the case of a male patient with biventricular hypertrophy suggesting amyloidosis, with an obstructive gradient in the right ventricle. LEARNING POINTS: Consider amyloidosis in a patient presenting with signs of congestive heart failure and low or microvoltage on ECG. It is important to examine right ventricle myocardium thickness, as hypertrophy not only occurs in the left ventricle, and look for a right ventricle outflow tract gradient. Analysis of speckle tracking of the myocardium will show deterioration of the basal and medium segments with normal apical segment motion.