Role of Tag Team Rounds in Accurate Diagnosis and Management of Cardiac Amyloidosis.

CLINICAL CONDITION

Cardiac Amyloidosis (CA).

KEY QUESTIONS

When should infiltrative cardiomyopathy be suspected, and what is the differential diagnosis? What is the diagnostic yield of a technetium Tc 99m pyrophosphate (Tc-PYP) scan, cardiac magnetic resonance (CMR), and molecular imaging with amyloid positron emission tomography (PET) tracer for CA? Are they able to distinguish between types of CA? What is the diagnostic yield of an endomyocardial biopsy for CA? How is transthyretin amyloid cardiomyopathy (ATTR-CM), treated and what is the prognosis? How do tag team rounds build on the current system of diagnosis and management of CA?

OUTCOME

Tag team rounds between heart failure, pathology, and hematology teams resulted in timely and accurate diagnosis of hereditary ATTR-CM in a patient with new-onset heart failure.

TAKE-HOME MESSAGE: A nonbiopsy diagnosis of CA is more challenging when a monoclonal gammopathy is present. Tag team rounds allow for correct and timely diagnosis of ATTR amyloid when a monoclonal protein is found.