When to Refer Carpal Tunnel
Syndrome Patients to Cardiology
Age
60-80 y/o (ATTR)
40-70 y/o (AL)Cardiac Signs
Unexplained LVH
Intolerance to antihypertensives
"Hypertrophic cardiomyopathy" after 60 y/oExtra-Cardiac Signs
Peripheral neuropathy
Spinal stenosis, biceps tendon rupture (ATTR)
Macroglossia, periorbital purpura, proteinuria, orthostatic Hypotension, diarrhea (AL)
Sperry 2016. Donnelly 2017
Faculty
Dr. Sperry and Dr. Khedraki are both cardiologists specialized in Advanced Heart Failure and Transplantation. Dr. Sperry practices at Saint Luke’s Mid America Heart Institute, MO. Dr. Khedraki practices at Scripps Clinic, CA.
Program faculty members are available for Q&A by teleconference or email. Please note that faculty will only provide educational and informational input. Please email info@p2psyncro.com to schedule. This is provided at no cost.
How do ATTR and AL differ in cardiac amyloidosis
In cardiac amyloidosis, misfolded amyloid proteins deposit in the heart muscle causing it to become thick and stiffened.
The two main types of cardiac amyloidosis are ATTR (also known as transthyretin amyloidosis) and AL (also known as light chain amyloidosis). These two types have similarities and differences in how the deposits are formed, how it presents clinically, and how it is diagnosed and treated.
Bone scintigraphy/technetium pyrophosphate (PYP) scan is used as a diagnostic test for ATTR. The algorithm for the diagnosis of ATTR has been published (Witteles 2019).
How many carpal tunnel syndrome patients have ATTR
In both ATTR type and AL type, amyloid deposits can also be found in the tenosynovium of carpal tunnel. Bilateral carpal tunnel syndrome often proceeds cardiac manifestations of amyloidosis for a number of years.
In men over 50 y/o and women over 60 y/o undergoing surgery for idiopathic carpal tunnel syndrome, 10% had amyloid deposits in the tenosynovium and 80% of these amyloid deposits are ATTR deposits (Sperry 2018, Sperry CME 2023). Other studies showed similar findings (Takashio 2023, DiBenedetto 2022).
Clinical Pearls
Why Do Cardiologists Misdiagnose ATTR
- Label hypertrophy as hypertensive cardiomyopathy.
- Rely on echo report, miss small cavity size/stroke volume and large/dysfunctional atria by image.
- Do not rule out AL with lab test first.
Faculty Discussion
Faculty
Dr. Sperry and Dr. Khedraki are both cardiologists specialized in Advanced Heart Failure and Transplantation. Dr. Sperry practices at Saint Luke’s Mid America Heart Institute, MO. Dr. Khedraki practices at Scripps Clinic, CA.
Program faculty members are available for Q&A by teleconference or email. Please note that faculty will only provide educational and informational input. Please email info@p2psyncro.com to schedule. This is provided at no cost.
How do ATTR and AL differ in cardiac amyloidosis
In cardiac amyloidosis, misfolded amyloid proteins deposit in the heart muscle causing it to become thick and stiffened.
The two main types of cardiac amyloidosis are ATTR (also known as transthyretin amyloidosis) and AL (also known as light chain amyloidosis). These two types have similarities and differences in how the deposits are formed, how it presents clinically, and how it is diagnosed and treated.
Bone scintigraphy/technetium pyrophosphate (PYP) scan is used as a diagnostic test for ATTR. The algorithm for the diagnosis of ATTR has been published (Witteles 2019).
How many carpal tunnel syndrome patients have ATTR
In both ATTR type and AL type, amyloid deposits can also be found in the tenosynovium of carpal tunnel. Bilateral carpal tunnel syndrome often proceeds cardiac manifestations of amyloidosis for a number of years.
In men over 50 y/o and women over 60 y/o undergoing surgery for idiopathic carpal tunnel syndrome, 10% had amyloid deposits in the tenosynovium and 80% of these amyloid deposits are ATTR deposits (Sperry 2018, Sperry CME 2023). Other studies showed similar findings (Takashio 2023, DiBenedetto 2022).