Abstract 12716: Ruptured Biceps Tendon: A Novel Non-Cardiac Clue to TTR Cardiac Amyloidosis
Introduction: Senile cardiac amyloidosis (SCA) is caused by deposition in the heart of protein derived from transthyretin (TTR), resulting in a restrictive cardiomyopathy, usually in elderly men. TTR deposition may also cause carpal tunnel syndrome which can precede the cardiomyopathy by 5-10 years.TTR deposits in other organs including tendons and ligaments has been described, but no clinical sequelae are recognized. Ruptured biceps tendon (RBT) has an annual incidence of < 2/100,000 in the general population. After seeing this condition in several patients with SCA we sought to determine the prevalence of RBT in a series of patients with SCA.
Methods: All patients with documented SCA seen at a specialized cardiac amyloidosis center were questioned about carpal tunnel syndrome and examined for RBT, characterized by a “popeye” muscle on arm flexion (figure).
Results: 99 patients with SCA (97 men) were seen over an 18 month period. 20 had RBT which had been unrecognized by the patient in four. 5/16 were unaware of the time of rupture. In the remainder, RBT occurred an average of 5.5 years prior to diagnosis of SCA. 13 (64%) patients with RBT also had carpal tunnel syndrome compared to 17/79 without RBT (p< 0.0001). RBT was not associated with more severe cardiac disease.
Conclusions: Ruptured biceps tendon, a rare disease in the general population is seen in 1/5 patients with SCA and, like carpal tunnel syndrome, precedes the cardiomyopathy by several years. The strong association with carpal tunnel syndrome in SCA suggests that the mechanism is due to TTR tendon deposition, and the rarity of ruptured biceps tendon in the general population indicates that its presence in an elderly male with heart failure should prompt consideration of a diagnosis of senile cardiac amyloidosis.
Author Disclosures: H.I. Geller: None. D. Trota: None. R.H. Falk: None.
- © 2015 by American Heart Association, Inc.