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Cardiac Amyloidosis Red Flags — EECC MCQ

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ModerateHeart FailureCardiac Amyloidosis Red FlagsEECC

A 75-year-old woman with suspected cardiac amyloidosis has bilateral carpal tunnel syndrome (operated bilaterally 5 years ago), lumbar spinal stenosis, and a ruptured biceps tendon. Her echocardiogram shows unexplained LVH with diastolic dysfunction. Which red flag features suggest cardiac amyloidosis?

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Correct answer: B — All of the above features are red flags for ATTR cardiac amyloidosis: bilateral carpal tunnel syndrome, lumbar spinal stenosis, and tendon rupture often precede cardiac diagnosis by 5-10 years

ATTR cardiac amyloidosis has characteristic extracardiac 'red flag' features that often precede cardiac diagnosis by years: (1) bilateral carpal tunnel syndrome (amyloid deposition in the transverse carpal ligament — present in 30-50% of ATTR patients, often requiring bilateral release); (2) lumbar spinal stenosis (amyloid in the ligamentum flavum); (3) spontaneous biceps tendon rupture; (4) peripheral/autonomic neuropathy (hereditary ATTR). The 2023 ESC Cardiomyopathy Guidelines emphasise that a high index of suspicion is needed: any patient with unexplained LVH/HFpEF plus these extracardiac features should be investigated for ATTR-CM. Early diagnosis is crucial as disease-modifying therapy (tafamidis) is available and most effective when started early.

Reference: ESC (2023): Guidelines on Cardiomyopathies