Sustained Ventricular Tachycardia as the first presentation of transthyretin amyloid cardiomyopathy.

Autor:	Ramos HR; Instituto Modelo de Cardiología. División Cardiología., Sagripanti M; Instituto Modelo de Cardiología. División Cardiología., Sandrin Á; Instituto Modelo de Cardiología. División Cardiología., Balestrini L; Instituto Modelo de Cardiología. División Cardiología., Balestrini V; Instituto Modelo de Cardiología. División Cardiología., Balestrini V; Instituto Modelo de Cardiología. División Cardiología., Celorrio V; Instituto Modelo de Cardiología. División Cardiología., Gigena A; Instituto Modelo de Cardiología. División Cardiología., Coll M; Instituto Modelo de Cardiología. División Cardiología., Zelaya F; Instituto Modelo de Cardiología. División Cardiología., Quiroga Castro W; Instituto Modelo de Cardiología. División Cardiología., Conci EC; Instituto Modelo de Cardiología. División Cardiología.
Jazyk:	angličtina
Zdroj:	Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina) [Rev Fac Cien Med Univ Nac Cordoba] 2024 Dec 13; Vol. 81 (4), pp. 768-782. Date of Electronic Publication: 2024 Dec 13.
DOI:	10.31053/1853.0605.v81.n4.44893
Abstrakt:	Transthyretin Amyloid Cardiomyopathy (ATTR-CM) was considered an uncommon disease until a few years ago, but advances in the epidemiology and non-invasive diagnostic tests have increased its timely detection. We report a 71 years-old man with history of hypertension and an incidental carcinoma of the left kidney detected 6 years ago, without heart failure who was performed cardiac magnetic resonance images (MRI) by suspicion of hypertrophic cardiomyopathy. Before his cardiologist be aware of the result, he suffered a severe sustained ventricular tachycardia (SVT) that required emergency cardioversion. Echocardiogram and cardiac MRI were suggestive for cardiac amyloidosis and the diagnosis was confirmed by scintigraphy with PYPTc99m (Perugini +3). Serum levels of light chains kappa and lambda were normal, and serum and urine immunofixation were negative; a genetic test had no variants, so supporting an ATTR-CM wild type. PET-CT did not detect metastasis of the renal tumor, but showed cardiac hypermetabolism and pericardial effusion. An implantable cardioverter defibrillator (ICD) was placed and after nine days a shock was delivered by the ICD due to a new event of SVT; in addition a Holter monitoring registered runs of asymptomatic atrial fibrillation. Etiologic treatment for ATTR-CM with Tafamidis 61 mg was started, amiodarone and rivaroxaban were added for control of arrhythmias and prevention of systemic embolism, respectively. After 14 months of follow-up, he is stable in class I NYHA. ATTR-CM is a complex disease, and the treatments should be indicated by a multidisciplinary team that consider the risks, benefits, and costs of each intervention. (Universidad Nacional de Córdoba)
Databáze:	MEDLINE
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