Key result
Wild-type cardiac transthyretin amyloidosis was strongly suspected in an 88-year-old male presenting with refractory hypotension, pulmonary edema, and characteristic echocardiographic findings.
Case Report (n=1)
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Advanced age, specific echocardiographic findings, and a history of carpal tunnel syndrome in a male presenting with severe heart failure strongly suggest wild-type cardiac transthyretin amyloidosis.
We present the case of an 88-year-old gentleman who presented to hospital septic with bilateral leg cellulitis, pulmonary oedema and hypotension. He had no history of heart disease but had had bilateral carpal tunnel releases. His condition deteriorated with refractory hypotension in spite of fluid filling, inotropic and vasopressor support. His echocardiogram showed an infiltrative cardiomyopathy with a speckled myocardium, severe concentric left and right ventricular increased wall thickness, diastolic dysfunction, biatrial dilatation and restrictive physiology in keeping with cardiac amyloidosis. He developed atrial fibrillation and worsening respiratory failure due to fluid overload and was intubated and ventilated but continued to decline and passed away. The degree of heart failure in the absence of ischaemia, the patient's advanced age, echocardiographic findings and past history of carpal tunnel syndrome in a male are strongly indicative of a diagnosis of wild-type cardiac transthyretin amyloidosis. We discuss the key features and intensive care management of this disease.
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Davies et al. (2016) conducted a case report in Wild-type cardiac transthyretin amyloidosis (n=1). Wild-type cardiac transthyretin amyloidosis was strongly suspected in an 88-year-old male presenting with refractory hypotension, pulmonary edema, and characteristic echocardiographic findings.
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