Cardiology: cardiac amyloidosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: cardiac amyloidosis

Sample item

A 72-year-old man has exertional dyspnoea, bilateral carpal tunnel syndrome and peripheral oedema. Echocardiography shows thickened left ventricular walls with a small cavity and preserved ejection fraction. Which ECG finding would strongly favour cardiac amyloidosis over hypertensive heart disease?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Low-voltage QRS complexes despite thick ventricular walls

In cardiac amyloidosis, extracellular amyloid fibrils thicken the myocardium without increasing the amount of electrically active muscle, so ECG voltages are low or normal while echocardiography shows thick walls. This voltage-mass discordance is a classic clue. Hypertensive hypertrophy and hypertrophic cardiomyopathy typically show high voltages.

Option by option

  • A. Very tall QRS voltages with strain pattern

    Tall voltages with strain are expected with true myocyte hypertrophy, as in hypertension or aortic stenosis.

  • B. Low-voltage QRS complexes despite thick ventricular walls (correct)

    Thick walls with low QRS voltage reflect infiltration instead of muscle hypertrophy.

  • C. Epsilon waves in the right precordial leads

    Epsilon waves are characteristic of arrhythmogenic right ventricular cardiomyopathy.

  • D. Delta waves with a short PR interval

    A delta wave signals ventricular pre-excitation in Wolff-Parkinson-White syndrome.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Low-voltage QRS complexes despite thick ventricular walls. In cardiac amyloidosis, extracellular amyloid fibrils thicken the myocardium without increasing the amount of electrically active muscle, so ECG voltages are low or normal while echocardiography shows thick walls.

Why is "Very tall QRS voltages with strain pattern" not the answer?

Tall voltages with strain are expected with true myocyte hypertrophy, as in hypertension or aortic stenosis.

Why is "Epsilon waves in the right precordial leads" not the answer?

Epsilon waves are characteristic of arrhythmogenic right ventricular cardiomyopathy.

Why is "Delta waves with a short PR interval" not the answer?

A delta wave signals ventricular pre-excitation in Wolff-Parkinson-White syndrome.

What concept does this question test?

It tests Cardiology: cardiac amyloidosis in General Medicine. This voltage-mass discordance is a classic clue. Hypertensive hypertrophy and hypertrophic cardiomyopathy typically show high voltages.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: cardiac amyloidosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.