The present case report refers to a 65-year-old male patient with subocclusion of the right coronary artery who had an inferior myocardial infarction that was treated with coronary angioplasty. The patient subsequently developed intractable angina pectoris in the absence of critical coronary stenosis at serial coronary angiography. Doppler wire velocity demonstrated an impaired coronary flow reserve. The patient died of cardiogenic shock. Postmortem examination revealed amyloid involvement of the media of the epicardial coronary arteries and severe amyloid deposition in the media and adventitia with obstruction of the lumen of the intramyocardial coronary arteries. Widespread ischemic areas were present in the myocardium with only slight amyloid deposition. In this patient myocardial infarction and unstable angina were a rare initial manifestation of primary amyloidosis.