Transthyretin Cardiac Amyloidosis in an Elderly Male With Heart Failure Intolerant to Guideline-Directed Medical Therapy

TL;DR

This paper presents a case of an elderly man with heart failure who was diagnosed with transthyretin cardiac amyloidosis after being unresponsive to standard treatments.

Contribution

The novelty lies in highlighting the importance of considering cardiac amyloidosis in patients unresponsive to guideline-directed heart failure therapy.

Findings

Transthyretin cardiac amyloidosis was diagnosed in a 73-year-old male with decompensated heart failure.

The patient was intolerant to guideline-directed medical therapy for heart failure.

Early diagnosis of cardiac amyloidosis can improve outcomes in heart failure patients.

Abstract

Cardiac amyloidosis arises when there is a deposition of abnormal proteins, called amyloids, in the myocardium. It can manifest as overt heart failure, conduction abnormalities, atrial and ventricular arrhythmia, cardiomyopathy, and aortic stenosis. Two main types of proteins identified in cardiac amyloidosis are light-chain amyloid and transthyretin amyloid. Cardiac amyloidosis, although common, is an underdiagnosed cause of heart failure in many cases. A high index of suspicion is needed to make a diagnosis, given that symptoms are not specific. Early diagnosis and treatment of cardiac amyloidosis are associated with reduced morbidity and improved survival. We present a case of a 73-year-old African American male with decompensated heart failure with reduced ejection fraction intolerant to guideline-directed medical therapy who was later found to have cardiac amyloidosis.

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