Differentials
Hypertrophic cardiomyopathy (HCM)
SIGNS / SYMPTOMS
Clinically difficult to distinguish HCM from amyloidosis.
INVESTIGATIONS
Echocardiogram meets diagnostic criteria for HCM, such as asymmetric septal hypertrophy.
Doppler echo with global longitudinal strain to exclude features of amyloidosis (i.e., restrictive filling changes).
Cardiac MRI with gadolinium: myocardial nulling after gadolinium injection is highly specific for cardiac amyloidosis.
Membranous glomerulopathy
SIGNS / SYMPTOMS
Clinically similar presentation in patients who present with nephrotic syndrome.
INVESTIGATIONS
Renal biopsy does not stain with Congo red.
Monoclonal gammopathy of undetermined significance (MGUS)-associated neuropathy
SIGNS / SYMPTOMS
Patients do not have significant degrees of proteinuria, hepatomegaly, or cardiomyopathy. Autonomic neuropathy is absent.
INVESTIGATIONS
Sural nerve biopsy does not stain with Congo red.
Multiple myeloma
SIGNS / SYMPTOMS
Bone pain and symptoms of anemia.
INVESTIGATIONS
Plain x-rays show lytic bone lesions, compression fractures, diffuse osteoporosis.
Low hemoglobin.
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