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Proceed CancelMultisystem involvement may be a sign of ATTR
ATTR develops due to the accumulation of amyloid deposits in the heart and other tissues of the body.1-4
Select the tabs below to explore red-flag signs and symptoms.
Tap the hot spots to explore the cardiac red-flag symptoms
*Including ARNi, ACEi, ARB, or beta blockers.
- LV wall thickening in the absence of hypertension
- Conduction system disease, atrial fibrillation
- Aortic stenosis (particularly low-flow/low grade)
- HFpEF alone or in combination with other noncardiac red-flag symptoms
- Intolerance to common HF medications*
- Elevated NT-proBNP and troponin I
- Shortness of breath
- Edema
Tap the hot spots to explore the neurologic red-flag symptoms
- Orthostatic hypotension
- Recurrent urinary tract infections
- Sexual dysfunction
- Altered sensation
- Length-dependent neuropathic pain and weakness
- Difficulty walking
Tap the hot spots to explore the musculoskeletal red-flag symptoms
- Rotator cuff injury
- Biceps tendon rupture
- Lumbar spinal stenosis
- Bilateral CTS
- Trigger finger
Tap the hot spot to explore the gastrointestinal red-flag symptoms
- Diarrhea
- Constipation
- Nausea
- Vomiting
- Unintentional weight loss
Tap the hot spot to explore the ocular red-flag symptoms
- Vitreous opacification
- Glaucoma
- Abnormal conjunctival vessels
- Pupillary abnormalities
Tap the hot spot to explore the renal red-flag symptoms
- Proteinuria
- Renal failure
- LV wall thickening in the absence of hypertension
- Conduction system disease, atrial fibrillation
- Aortic stenosis (particularly low-flow/low grade)
- HFpEF alone or in combination with other noncardiac red-flag symptoms
- Intolerance to common HF medications*
- Elevated NT-proBNP and troponin I
- Shortness of breath
- Edema
- Orthostatic hypotension
- Recurrent urinary tract infections
- Sexual dysfunction
- Altered sensation
- Length-dependent neuropathic pain and weakness
- Difficulty walking
- Rotator cuff injury
- Biceps tendon rupture
- Lumbar spinal stenosis
- Bilateral CTS
- Trigger finger
- Diarrhea
- Constipation
- Nausea
- Vomiting
- Unintentional weight loss
- Vitreous opacification
- Glaucoma
- Abnormal conjunctival vessels
- Pupillary abnormalities
- Proteinuria
- Renal failure
Not a comprehensive list of all the symptoms associated with ATTR amyloidosis. Each patient may not experience all of these symptoms or may not experience them at the same time.
ACEi=angiotensin-converting enzyme inhibitor; ARB=angiotensin receptor blocker; ARNi=angiotensin receptor-neprilysin inhibitor; ATTR=transthyretin-mediated amyloidosis; CTS=carpal tunnel syndrome; HF=heart failure; HFpEF=heart failure with preserved ejection fraction; LV=left ventricular; NT-proBNP=N-terminal prohormone of brain-type natriuretic peptide.
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Suspecting ATTR
References:
- Koike H et al. Biomedicines. 2019;7(1):11.
- Adams D et al. Neurology. 2015;85(8):675-682.
- Adams D et al. Curr Opin Neurol. 2016;29(suppl 1):S14-S26.
- Mohty D et al. Arch Cardiovasc Dis. 2013;106(10):528-540.
- Kittleson MM et al. Circulation. 2020;142(1):e7-e22.
- Kittleson MM et al. J Am Coll Cardiol. 2023;81(11):1076-1126.
- Maurer MS et al. Circ Heart Fail. 2019;12(9):e006075.
- González-López E et al. Eur Heart J. 2015;36(38):2585-2594.
- Maloberti A et al. Int J Cardiol Cardiovasc Risk Prev. 2024;21:200271.
- Dharmarajan K et al. J Am Geriatr Soc. 2012;60(4):765-774.
- Castaño A et al. Eur Heart J. 2017;38(38):2879-2887.
- Conceição I et al. J Peripher Nerv Syst. 2016;21(1):5-9.
- Witteles RM et al. JACC Heart Fail. 2019 Aug;7(8):709-716.
- Nativi-Nicolau JN et al. Heart Fail Rev. 2022;27(3):785-793.
- Brito D et al. Glob Heart. 2023;18(1):1-47.
- Mitter SS et al. ISA Congress 2020. Poster PT135.
- Rintell et al. Orphanet J Rare Dis. 2021;16(1):70.
- Maurer MS et al. J Am Coll Cardiol. 2016;68(2):161-172.
- Rozenbaum MH et al. Cardiol Ther. 2021;10(1):141-159.
