The cause of death, as recorded on the death certificate, was listed as

1a Congestive heart failure
1b Amyloidosis
1c Myeloma

The patient's heart appeared pale on autopsy; this was due to the build-up of amyloid protein within the myocardium, which restricted the myocardial movement and therefore prevented the heart from beating efficiently. this initially presented as oedema and dyspnoea, but then as cardiac output decreased even more the patient became hypotensive and eventually cardiac output was too low to adequately perfuse the cardiac muscle itself and the patient arrested and died.

Amyloidosis is often myeloma-associated: the IgG light chains produced in abundance in myeloma are deposited in many organs including the liver, heart, spleen and kidneys, and can lead to failure of these organs. In this case, two out of the three diagnostic criteria were fulfilled so it's likely that this lady did have myeloma.

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