P350 LOOKING FOR RED FLAGS

Abstract Case report: a 81 years old man with systemic hypertension, dyslipidemia, past smoking habit, was admitted to the ER of our hospital acute decompensated heart failure. Since July he complained worsening dyspnea and paroxysmal nocturnal dyspnea. His blood pressure 155/80 mmHg, HR 78 bpm in atrial fibrillation. He reported myocardial infarction at age 32, thenceforth underwent periodic cardiac check–up. From 2013 had developed suspended Amiodarone because dysthyroidism, rate control obtained Bisoprolol. In 2015, coronary angiography for positive scintigraphy showed absence lesions. During same hospitalization there evidence bradycardia (35 bpm). 2016, MR subendocardial intramyocardial fibrosis mid–basal wall resembling post ischemic events. carpal tunnel syndrome surgery. actual hospitalization, EKG fibrillation (78 bpm), complete left bundle branch block (both already known). Serum urinary light–chain assessment determination immunoglobulin light chains levels were negative AL amyloidosis. The echocardiogram documented: hypertrophy interventricular septum, mildly reduced LV systolic function (EF=43%). Invasive CMR showed: ventricular size upper limit normal septum anterior wall, diffused transmural LGE, focal fibroadipose infiltration lower basal SIV. multiple episodes non sustained tachycardia occurred, so that CRT–D device implanted secondary prevention. There strong suspicion amyloidosis definitive diagnosis by use 99m Tc coupled haematologic tests (already done, resulted negative). Scintigraphy uptake radiotracer greater than bone (Grade 3 Perugini score). Conclusion is restrictive cardiomyopathy. Early really important, firstly, new treatments, such as TTR stabilizer, have transformed this once incurable disease treatable condition. Secondly, diagnostic tools now allow earlier more accurate non–invasive diagnosis. It crucial put attention on red flags which be found rise clinical suspicion.