Background:

Heart failure with preserved ejection fraction (HFPEF) in the elderly is common, at least 50% of cases of heart failure in the elderly belong to this category. Often these patients have other comorbidities as: systemic hypertension, diabetes or ischemic heart disease that can partially explain the diastolic dysfunction; at least 25% autopsy studies discloses amyloid deposits in hearts of octogenarians, often without clinical relevance. Usually physicians do not think on amyloidosis as etiologic factor and probably it is underdiagnosed because of difficulties making histologic diagnosis based on endomyocardial biopsies.

Case report:

A patient with HFPEF and cardiac senile amyloidosis is described, different modalities for making non-invasive/non biopsy diagnosis of transthyretin amyloidosis (ATTR) are discussed.

Conclusion:

Cardiac senile amyloidosis is probably a not so uncommon cause of HFPEF.