Sudden death can occur in up to 50% of patients with cardiac amyloidosis.
Causes of sudden death in light chain cardiac amyloidosis:
(1) pulseless electrical activity
(2) ventricular arrhythmia
(3) thromboemboli (from intra-atrial thrombi)
(4) conduction system disorder with bradyarrhythmia
Reasons for failure to detect:
(1) absence of heart failure or other indication of heart disease
(2) unrecognized amyloidosis
(3) inadequate pathologic exam
When to suspect cardiac amyloidosis at autopsy:
(1) sudden cardiac death with normal coronary arteries
(2) amorphous light pink extracellular deposits, especially around blood vessels
