Module 6 Case 1: Case of Biopsy-Proven Wild-Type ATTR-CM With Discordant Imaging

Not all cases of transthyretin cardiac amyloidosis (ATTR-CM) follow the textbook diagnostic pathway. This lesson examines a complex case of wild-type ATTR-CM with discordant imaging results, normal nuclear scintigraphy but abnormal CMR findings, ultimately diagnosed via endomyocardial biopsy. Learners will review diagnostic red flags, limitations of bone scintigraphy, and the interpretive nuances of CMR and laboratory testing. Emphasis is placed on recognizing when to escalate to biopsy and how to integrate all available data in ambiguous or early-stage presentations. This case reinforces that clinical suspicion, even in the face of conflicting test results, must guide definitive diagnosis and early treatment.