Cardiac Transthyretin Amyloidosis: Hidden in Plain Sight
Table 1
Red flags symptoms and findings of ATTR amyloidosis.
Findings
Clinical symptoms
CHF without hypertension, bilateral CTS, LSS, newly diagnosed CHF over the age of 60, angina without CAD, peripheral neuropathy, dysautonomia, and repeated mild troponin increases [3, 5, 7]
Electrocardiogram
Diffuse low voltage, low voltage to mass ratio, evidence of pseudoinfarction, pathologic Q-waves without prior infarction or wall motion abnormality, and heart blocks [1]
Echocardiogram
Left ventricular wall thickness ≥12 mm, left atrial enlargement, and diastolic dysfunction. Amyloid appears speckled in the myocardium [1, 3, 7, 8].
Cardiac MRI
LGE progresses from the subendocardiocardial tissue to a more diffuse pattern as the amyloid infiltration increases [1]
