P61 | Recurrent lipothymias: an unusual and challenging diagnosis

S. Di Sante¹, E. D’Agostino¹, A. Cagnetti², A. Lorizio¹, P. Marzano¹, L. De Berardis¹, A. Falco¹ | ¹Medicina Interna, PO “Maria SS dello Splendore”, Giulianova (TE), ²Cardiologia, PO “Maria SS dello Splendore”, Giulianova (TE), Italy

Background: Transthyretin amyloidosis (ATTR) is an infiltrative disease due to deposition of transtyretin fibrils. It is a systemic disorder whose clinical manifestations are extremely heterogeneous. Diagnostic suspicion should be based on the presence of signs in a suggestive symptomatic context.
Case report: A 82-year-old man was hospitalized in September 2021 for recurrent lipothymias. He had a medical history of chronic ischemic heart disease and carpal tunnel syndrome. ECG showed first-degree atrioventricular block, computed tomography of the chest areas of pulmonary consolidation, echocardiogram eccentric remodelling of the left ventricle, severe aortic stenosis, mild pericardial effusion. The patient was discharged diagnosed with bilateral pneumonia and severe aortic stenosis with a program of TAVI after resolution of the infection. The patient returned to our observation in November 2022 due to increasingly frequent lipothymias. He had undergone TAVI in March 2022. Echocardiogram showed bioprosthetic valve in situ, eccentric remodelling with interventricular septum of 14 mm. In the suspicion of an infiltrative disease a haematologic study was performed excluding amyloid light chain (AL) amyloidosis. Tc-99m bone scan showed a Perugini score grade 2-3. Diagnosis of ATTR was made and the patient was referred to a reference center.
Conclusions: Ever-increasing knowledge about ATTR has led to important results in the diagnosis and therapy of the disease with a positive impact on quality of life and reduction in hospitalizations.