Would testing for ATTR cardiac amyloidosis be considered in an older patient with bilateral carpal tunnel surgeries and multiple spinal stenosis surgeries, but no obvious cardiac symptoms?

I would not look for ATTR-CM in the absence of cardiac findings such as abnormal echo (increased LV thickness) or conduction abnormalities that are suggestive.

Only 10% of patients with bilateral CTS have ATTR-CM.

I would do an echo if not done and review ECG.

As much as we are concerned about underdiagnosing cardiac amyloidosis, we have to be careful about inappropriate evaluations also. That will lead to needless testing and worry for the patient.

David Wolinsky, MD FACC MASNC
Director Cardiac Amyloid Center
Cleveland Clinic Florida