skip to main content

Transthyretin cardiac amyloidosis — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

HardCardiovascularTransthyretin cardiac amyloidosisABIM Board

A 77-year-old man has progressive dyspnea, bilateral carpal tunnel syndrome, and lumbar spinal stenosis. Echocardiography shows concentric LV wall thickening with apical sparing strain. ECG shows low limb-lead voltage. Serum free light-chain ratio is normal and immunofixation is negative. Which of the following is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Transthyretin cardiac amyloidosis

Older age, carpal tunnel syndrome, increased LV wall thickness, low voltage, and apical sparing strain are characteristic of transthyretin cardiac amyloidosis. Excluding monoclonal protein helps distinguish ATTR from AL amyloidosis before bone-avid tracer scintigraphy.

Reference: 2023 ACC Expert Consensus Decision Pathway on Cardiac Amyloidosis