






- 65-year-old African American male
- History of hypertension
- Fatigue
- Lower extremity edema
- Numbness, tingling in toes, neuropathic pain
- Shortness of breath, dizziness on exertion
- Father died of heart failure at age 62





- hATTR amyloidosis
- Amyloid light chain (AL) amyloidosis
- Hypertrophic cardiomyopathy
- Hypertensive heart disease


Thanks for narrowing down the conditions you would consider. In order to continue toward a diagnosis, here are the results of some tests and labs that were ordered by the case physician:
- Labs: Elevated NT-proBNP and troponin I; serum and urine negative for monoclonal protein
- Electrocardiography: Low QRS voltage
- Echocardiography: LV wall thickness 16 mm at basal anterior septum, 18 mm at anterior wall, granular speckling, indicative of refractile myocardium
- 99mTc-PYP scintigraphy scan: Grade 3 myocardial radiotracer uptake




