When to Suspect Cardiac Amyloidosis

A 66-year-old African American software engineer with hypertension (diagnosed 2 years ago on his annual exam) is referred to your clinic with newly diagnosed Heart failure with preserved ejection fraction (HFpEF). His echocardiogram shows biatrial enlargement, concentric left ventricular hypertrophy (LVH) with a wall thickness of 1.6 cm, and evidence of diastolic dysfunction. His blood pressure has been well controlled on a low dose of one antihypertensive medication (lisinopril 2.5mg daily), and he has had regular medical checkups for his entire life.

  • Additional past medical history: Torn right biceps muscle
    • "I was carrying my heavy laptop bag with extra batteries"
  • Past surgical history: Bilateral carpal tunnel release surgery 15 years ago with repeat surgery 1 year ago
    • "Because I am on the computer all the time for my job"
  • Medications: Lisinopril 2.5 mg daily. He reports feeling very "dizzy" if he takes a higher dose.
  • Family history: Mother, aunt, and grandfather had hypertensive heart disease and "CHF"

Which of the following is NOT a clinical clue in this patient's case that should make you think about cardiac amyloidosis?

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