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Characteristic Electrocardiogram Findings in ATTR Cardiac Amyloid & Other Infiltrative Disease

Description

An 85 year old female presented with clinical evidence of volume overload, an echocardiogram revealing severe concentric LVH and moderate RVH, plus this electrocardiogram showing rate controlled atrial fibrillation meeting low voltage criteria in limb leads (QRS < 5 mm) with evidence of left ventricular hypertrophy strain pattern (largest precordial R+S > 45 mm & ST depression with TWI in V5-V6) and wide QRS at 153 ms. The compilation of atrial arrhythmia, low voltage, and LVH are concerning for infiltrative cardiac disease. This particular patient underwent technetium pyrophosphate (TcPYP) scanning that revealed significant amyloid transthyretin (ATTR) deposition in the heart.

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