Hirano Tatsuhiro, Takeoka Mayumi, Yamano Michiyo, Kawasaki Tatsuya
Cardiology, Matsushita Memorial Hospital, Moriguchi, JPN.
Central Clinical Laboratory, Matsushita Memorial Hospital, Moriguchi, JPN.
Cureus. 2023 Aug 3;15(8):e42925. doi: 10.7759/cureus.42925. eCollection 2023 Aug.
Transthyretin (ATTR) cardiac amyloidosis has recently received increased attention; however, the diagnosis is often delayed. We present a case of ATTR cardiac amyloidosis in which a comprehensive history-taking and focused physical examination played an important role in establishing the diagnosis. A 75-year-old man was referred to the cardiology department for left ventricular hypertrophy on electrocardiography. No fourth sound was audible despite concentric biventricular hypertrophy and diastolic dysfunction on echocardiography. Additional history-taking revealed that he had undergone bilateral carpal tunnel syndrome surgery almost 35 years earlier and had a biceps tendon rupture about 15 years earlier; bunching of the arm on flexion, or Popeye's sign, was noted. Technetium-99m-pyrophosphate showed diffuse uptake not only in both ventricles but also in both atria. The findings were consistent with the absence of the fourth sound. The present case highlights the importance of a focused physical examination as well as history-taking as a clue to ATTR cardiac amyloidosis in patients with unexplained left ventricular hypertrophy.
转甲状腺素蛋白（ATTR）心脏淀粉样变性最近受到了更多关注；然而，诊断往往会延迟。我们报告一例ATTR心脏淀粉样变性病例，其中全面的病史采集和重点体格检查在确立诊断中发挥了重要作用。一名75岁男性因心电图显示左心室肥厚被转诊至心内科。尽管超声心动图显示双心室向心性肥厚和舒张功能障碍，但未闻及第四心音。进一步的病史采集发现，他在近35年前接受了双侧腕管综合征手术，约15年前发生了肱二头肌肌腱断裂；注意到屈肘时手臂出现“大力水手征”（即屈肘时上臂肌肉隆起）。锝-99m焦磷酸盐显像显示不仅在两个心室，而且在两个心房均有弥漫性摄取。这些发现与未闻及第四心音一致。本病例强调了重点体格检查以及病史采集作为不明原因左心室肥厚患者ATTR心脏淀粉样变性线索的重要性。
