[Heart failure as clinical onset of essential mixed cryoglobulinemia].

The case of a 58-year old man affected by heart failure on ischemic basis, as clinical onset of essential mixed cryoglobulinemia (EMC) is reported. Laboratory assays, ECG at rest and exercise electrocardiogram, echocardiogram, myocardial scintigraphy, cardiac catheterization with coronarography, hepatic, bone and kidney biopsies confirmed the diagnosis. Cases of primitive heart involvement are rarely reported and are, usually, due to myocardial infarction. Nevertheless in the published series of cases, heart failure is often coupled with EMC and, not seldom, is the cause of death. In the present case heart failure was the dominant element of clinical symptomatology and wasn't consequent to renal involvement or hypertension, but was sustained by a myocardial contractile deficiency, on ischemic basis, with undamaged coronary circle at angiography. Therefore heart failure was ascribed to an involvement of coronary microcirculation in the course of systemic vasculitis.