Autonomic clues in cardiology
bilateral CTS, trigger finger, GI disturbance, lack of sweating, syncope or heat intolerance are all examples of what?
What is : Red Flag Symptoms for amyloids
When echocardiography suggests severe aortic stenosis but the transvalvular gradient is low due to reduced stroke volume and a thickened ventricle, this diagnostic step helps confirm true severity.
What is: order a genetic test and rule out amyloid!
Percentage of US population with HFpEF that has amyloid? What is ratio for hereditary patient?
What is: 10%, 2/5
Septal thickness of this measurement or greater should merit adding strain to the echo
1.2 CM
In Europe- (1.2 Male and 1.4 Female- pretty thick!)
which commonly misdiagnosed condition in neurology is NOT associated with symptomatic autonomic dysfunction?
What is : CIDP
what is another word for severe weight and muscle loss…32% of hATTR can’t maintain weight because of this condition? Starts with a C
What is: Cachexia
during an echo, Look for concentric LV thickening with small or normal cavity size, often with RV free wall thickening; the Dr. may want to ask, Is the ventricle thick with no clear hypertension history to explain it?” If there is not a history of hypertenstion, what should they suspect?
what is: Cardiac Amyloidosis
you multiply this by albumin levels to account for edema and diuretics when considering patients' "failure to thrive"
what is: Modified BMI
When the heart is stiff and resists filling, it may still eject 50% of the blood it received, but because the incoming volume is reduced, this leads to a decreased stroke volume and cardiac output. What diastolic condition is this referred to as which is a common patient type for amyloid?
What is HFpEF
If you see orthostatic hypotension and peripheral neuropathy, the saying is assume what?
What is: assume amyloid until proven otherwise!
It is good to uspect amyloid when complaining of back and neck pain, and this type of relief happens when the patient bends over?
What is: it eases the pain
which valvular condition should include screening for amyloid prior to intervention?
what is: TAVR or aortic stenosis
70% of hereditary patients experience AFib- what condition is often absent but commonly presented to cardiologist for patients AFib and amyloid?
what is Afib without history of hypertension
This can be increased on an MRI in an amyloid patient
what is extracellular volume?
What percentage of CTS with non- dominant hand test positive for amyloid?
what is : 60%
delayed intervention has what type of consequences
What are: irreversible- nerve damage is permanent
Is apical sparing suggestive or diagnostic?
What is: suggestive
With amyloid fibrils, the signals to vasoconstrict are lost- it is not uncommon on EKG to see what type of timing result- starts with a p
What is prolongation
On speckle-tracking echocardiography, this strain pattern—nicknamed “the cherry on top” for preserved apical strain with reduced basal and mid-wall strain—should prompt closer scrutiny.
what is global longitudinal strain
sometimes, doctors will attribute a patient's neuropathy symptoms to another condition considered a red flag but commonly treated and not identified as a reason to suspect amyloid? Neuro pain APP's often treat this condition?
What is : Lumbar stenosis
You need this in order to make a differential diagnosis, and should have a low threshold for considering this?
what is : genetic testing
if the echo raises suspicion for amyloid, the typical next steps include cardiac MRI with late gadolinium enhancement and T1 mapping, serum/urine testing for light chains (AL), and what?
what is: bone scintigraphy (PYP/DPD/HMDP) for ATTR.
In diabetes… neuropathy correlates with poor glycemic control and patients may display signs and symptoms of retinopathy and nephropathy-but as a rule of thumb, unless they have all those factors- and they are experiencing autonomic dysfunction – it is not what type of neuropathy
what is : diabetic
In a patient who’s hypotensive and borderline cardiogenic shock on a low pacemaker setting, within EP, what tends to be needed and should be looked for as a red flag for an amyloid patient?
What is: pacemaker continually needs to be increased
this type of treatment has shown to reverse some autonomic impairment anecdotally for amyloid?
what are: Silencers