A 72-year-old man comes to the GP for a 2-month history of dull lower back pain . He has hypertension controlled with nifedipine. His vitals are: temperature 98.8F, HR 120, RR 12, BP 145/90. Physical examination shows tenderness to palpation over the L3-L4 vertebrae. There is an S4 gallop on auscultation. Serum protein electrophoresis shows a monoclonal IgG kappa spike. Transthoracic echocardiography shows left ventricular wall thickening and decreased diastolic compliance. Which of the following is the most likely explanation for the cardiac findings in this patient?
Metastatic malignancy
Myocardial necrosis
Myocardial infiltration by amyloid
Myocardial infiltration by plasma cells
Myocardial infiltration by plasmacytoid cells
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Cut-to-the-chase Answer (1:17):
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HY USMLE Answer (6:50):
