A case of cardiac amyloidosis is described in which clinical and scintigraphic findings were those of ischemic heart disease. Electrocardiogram disclosed low voltages in the peripheral leads and a pattern of anterior pseudo-myocardial infarction. 2D-echocardiography showed thickened cardiac walls and a "granular sparkling" appearance of the septum. The curve of the left ventricular diastolic pressure suggested impaired ventricular relaxation without a true dip-plateau morphology. Stains for amyloid of rectal biopsy specimens were negative. Histological study of left ventricular endomyocardial biopsy indicated the presence of basophilic material among the myocytes; at ultrastructural examination this infiltrating substance resulted to be amyloid. This case stresses the effectiveness of ultrastructural investigation of left ventricular endomyocardial biopsy in the diagnosis of infiltrative and/or metabolic cardiac disorders.
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