Pulmonary embolism is a potentially fatal condition that encountered in practice and mandates prompt identification and management. If left untreated, a delay in diagnosis can be catastrophic for the patient and carry a significant risk of death.

Learning points• Cardiac manifestations like syncope, arrythmia and heart failure rarely present as initial manifestations of AL-amyloidosis.• A high index of suspicion is required to make the diagnosis, especially in an adult who presents with cardiac manifestations, like heart failure and syncope and arrythmias.