PO0048 - A Cardiac Amyloidosis Presentation: Atrial Mass Versus Thrombus

Background: ATTR-CM is a rare and progressive disease due to the buildup of amyloid fibrils in the heart, causing the heart muscle to become stiff, eventually resulting in heart failure.

Aims: To proper diagnose from the two sub-types of ATTR-CM: hereditary, also known as variant, which is caused by a mutation in the transthyretin gene and can occur in people as early as their 50s and 60s or with no mutation and associated with aging. Often the disease is diagnosed only after symptoms have become severe.

Methods: A density identified in the left atrium commonly leads to the presumptive diagnosis of an atrial myxoma. However, other pathologies, such as atrial thrombi, can mimic in clinical presentation and appearance to a myxoma. Clinically, these pathologies may lead to obstructive symptoms such as syncope, palpitations, or sudden cardiac death. At present, echocardiography, magnetic resonance imaging, or computed tomography can be used to identify such masses, but fall short of identifying the primary cause

Results: Currently, there are no definitive guidelines on the anticoagulation needed or the duration required for the resolution of cardiac thrombi secondary to amyloidosis. However, there have been several studies on treatment modalities. It is possible that early detection of amyloidosis, vigilant screening for intracardiac thrombosis with early anticoagulation might improve the prognosis. Effective anticoagulation might reduce thromboembolism, which is a significant contributor to mortality in cardiac amyloid patients

Conclusion(s): This case explores the challenges in the diagnosis and management of intra-atrial thrombi with cardiac amyloidosis, commonly seen in the elderly population. Densities found on echocardiograms may presumptively be diagnosed as myxomas; however, other pathologies may mimic their clinical presentations, such as atrial thrombi. In conclusion, in agreement with the previous case reports, our case confirms
the need for prospective studies addressing the management of cardiac amyloidosis in patients with a thrombotic presentation.