NPPB and cardiac amyloidosis: The pharmacological management of CMD typically includes beta-blockers to reduce the myocardial oxygen demand.14 However, in cardiac amyloidosis, particularly the AL type, beta-blockers may exacerbate symptoms due to autonomic dysfunction and a low-output state.15 In the present case, the initiation of bisoprolol led to worsening symptoms and elevated BNP levels.