Correct!
2. Endomyocardial biopsy
Endomyocardial biopsy is the gold standard for diagnosis of cardiac amyloid (3). Risk of this procedure is right ventricular perforation leading to cardiac tamponade which is rare. Fat pad biopsy is 60-80% sensitive in AL amyloid so that a negative fat pad biopsy does not rule out amyloid disease. When suspecting amyloid disease, typical work up starts with serum and urine immunofixation and serum free light chain ratio. If these are normal, there is high negative predictive value in ruling out diagnosis of the most common forms of amyloid. Lastly, technetium pyrophosphate scan can be used to determine if there is uptake in the myocardium. A bone marrow biopsy may also be needed to confirm and determine the plasma cell clone.
What medications are relatively contraindicated in the treatment of amyloid heart failure? (Click on the correct answer to proceed to the sixth of seven pages)