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Cardiac amyloidosis — RCPSC IM MCQ

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HardCardiologyCardiac amyloidosisRCPSC IM

A 72-year-old man has heart failure with preserved ejection fraction, bilateral carpal tunnel syndrome and progressive neuropathy. Echocardiography shows concentric left ventricular thickening with apical sparing on strain imaging. Serum and urine immunofixation and free light chain ratio are normal. Technetium-pyrophosphate scintigraphy shows grade 3 myocardial uptake. What is the most likely cause?

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Correct answer: D — Transthyretin amyloid deposition

Positive bone-avid tracer uptake with absent monoclonal protein strongly supports transthyretin cardiac amyloidosis. AL amyloidosis must be excluded because treatment and urgency differ.

Reference: CCS heart failure guidance; Canadian amyloidosis practice resources