SHM Converge Scientific Abstract ePoster Gallery-Unmasking the Hidden Culprit: Cardiac Amyloidosis as a Cause of Chronic Dyspnea

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This case describes a 77-year-old man with a one-year history of chronic exertional dyspnea and recurrent heart failure with preserved ejection fraction (HFpEF) exacerbations. His medical history included atrial fibrillation, hypertension, hyperlipidemia, type 2 diabetes, and obstructive sleep apnea. Despite guideline-directed therapy, his symptoms persisted. Prior testing showed preserved ejection fraction (50–55%), grade III diastolic dysfunction, low-voltage QRS on ECG, and non-obstructive coronary arteries, raising concern for an infiltrative cardiomyopathy.<br /><br />At a tertiary center, exercise right heart catheterization demonstrated elevated filling pressures and a reduced cardiac index, supporting significant cardiac dysfunction. A technetium-99m pyrophosphate (PYP) scan showed marked myocardial tracer uptake in both ventricles, strongly suggesting transthyretin (ATTR) cardiac amyloidosis. The patient was started on tafamidis and subsequently experienced substantial symptomatic improvement.<br /><br />The report emphasizes that cardiac amyloidosis is an underrecognized cause of unexplained dyspnea and HFpEF, especially in older adults with diastolic dysfunction, arrhythmias, unexplained ventricular thickening, or symptoms out of proportion to coronary disease. Diagnosis often requires a multimodal approach using echocardiography, cardiac MRI, and nuclear scintigraphy, with biopsy reserved for uncertain cases.<br /><br />The key takeaway is that maintaining a high index of suspicion for cardiac amyloidosis can prevent delayed diagnosis and allow earlier disease-specific treatment, which may improve quality of life and outcomes.

Asset Subtitle

Albert A. Annan

Meta Tag

Author List Aitazaz Shah, Albert A. Annan, Nkoyo Effiom, Samar Sumrain, Sarah Misbah

Category Clinical Vignettes

Concept Cardiac Amyloidosis

Concept Heart Failure with Preserved Ejection Fraction

Concept PYP Scan

Concept AL Amyloidosis

Concept Systemic Amyloidosis

Distinguished Non-Finalist

Presenter Organization Texas Health Resources HEB/Denton

Presenting Author Albert A. Annan

Track Adult

Keywords

cardiac amyloidosis

HFpEF

transthyretin amyloidosis

tafamidis

dyspnea

diastolic dysfunction

PYP scan

infiltrative cardiomyopathy

atrial fibrillation

older adults

Cardiac Amyloidosis

Heart Failure with Preserved Ejection Fraction

PYP Scan

AL Amyloidosis

Systemic Amyloidosis