Recognizing Cardiac Amyloidosis Symptoms in Women 73+ — A Guide to Early Clues and Empowered Action

If you or someone you love is a woman over 73 experiencing unexplained fatigue, tingling or numbness in both hands (especially with prior carpal tunnel surgery), and normal-looking heart function on standard tests — it’s time to consider cardiac amyloidosis symptoms women 73+ as a possible cause. While often overlooked, this condition affects an estimated 15–20% of adults over age 80 with heart failure and preserved ejection fraction — and women are disproportionately represented among those with wild-type transthyretin amyloidosis (ATTRwt), the most common form in older adults.

For many people aged 50 and above, heart health concerns are often assumed to be “just aging” — leading to delayed diagnosis and missed treatment windows. A common misconception is that heart failure always means a weakened, “floppy” heart (reduced ejection fraction); in reality, up to 50% of heart failure cases in older adults involve preserved ejection fraction — and among these, ATTR amyloidosis is one of the most treatable yet underrecognized causes. Another myth is that carpal tunnel syndrome is purely a wrist issue: bilateral carpal tunnel — especially if surgically treated more than once — is now recognized as a red-flag systemic sign, not just a local problem.

Understanding cardiac amyloidosis symptoms women 73+ empowers patients and clinicians alike to move beyond symptom dismissal and toward timely, targeted evaluation.

Why Cardiac Amyloidosis Symptoms Women 73+ Matter More Than You Might Think

Transthyretin amyloidosis (ATTR) occurs when misfolded transthyretin proteins build up as stiff, waxy deposits — primarily in the heart, nerves, and tendons. In older women, the wild-type form (ATTRwt) is far more common than the hereditary type (ATTRv). Unlike many cardiovascular conditions, ATTRwt does not preferentially affect men; in fact, recent data from the Mayo Clinic and UK National Amyloidosis Centre show women account for nearly 60% of diagnosed ATTRwt cases over age 75.

The reason this matters lies in how the disease presents. Women over 73 often experience subtle, progressive symptoms that mimic common age-related changes:

• Unexplained fatigue: Not just “tired after walking,” but profound exhaustion that persists despite rest, sleep, and adequate nutrition — often worsening over 6–12 months.
• Bilateral carpal tunnel syndrome: Occurring in both wrists, sometimes requiring multiple surgeries, and frequently appearing years before heart symptoms emerge. Up to 75% of women later diagnosed with ATTRwt report bilateral carpal tunnel — often the earliest clinical clue.
• Preserved ejection fraction (EF ≥50%): Standard echocardiograms may appear “normal” or show only mild thickening (left ventricular hypertrophy), masking underlying infiltration.

Because these signs don’t fit classic heart failure patterns, they’re frequently attributed to deconditioning, depression, or arthritis — delaying diagnosis by an average of 2–3 years.

Key Diagnostic Clues: Beyond the Echocardiogram

Accurate recognition begins with looking for three interconnected red flags — what experts now call the “triad of suspicion”:

1. Clinical triad: Unexplained fatigue + bilateral carpal tunnel ± lumbar spinal stenosis or biceps tendon rupture
2. ECG red flags: Low-voltage QRS complexes (<5 mm in limb leads or <10 mm in precordial leads) plus pseudo-infarct pattern (QS waves in V1–V3 without prior MI history)
3. Echocardiographic clues: Increased left ventricular wall thickness (often >12 mm) without hypertension or aortic stenosis, speckled myocardium (“granular sparkling”), and abnormal strain patterns — especially reduced global longitudinal strain (GLS) with apical sparing

Importantly, blood tests like BNP or NT-proBNP are often markedly elevated — even in the absence of overt heart failure — making them valuable screening tools. A BNP >350 pg/mL or NT-proBNP >1,800 pg/mL in this demographic should prompt further investigation, even if echo appears reassuring.

Nuclear imaging with bone-avid tracers (e.g., technetium-99m pyrophosphate, or PYP scan) has emerged as a highly specific, non-invasive first-line test for ATTR cardiac amyloidosis. When combined with absent monoclonal protein on serum free light chain assay and immunofixation, a grade 2–3 PYP scan offers >95% diagnostic accuracy — eliminating the need for heart biopsy in most cases.

Who Should Prioritize This Evaluation?

While anyone over 73 with the triad deserves consideration, certain groups benefit most from early assessment:

• Women who’ve had bilateral carpal tunnel release, especially if surgery occurred more than once or before age 70
• Patients with heart failure with preserved ejection fraction (HFpEF) and no clear cause (e.g., obesity, diabetes, or hypertension alone doesn’t explain severity)
• Individuals with unexplained neuropathy (e.g., autonomic symptoms like orthostatic dizziness or gastrointestinal slowing) alongside cardiac symptoms
• Those with a family history of cardiomyopathy or unexplained heart failure, though ATTRwt is not inherited — distinguishing it from hereditary ATTR requires genetic testing

It’s also worth noting: while men develop ATTRwt earlier (often late 60s), women tend to present later — commonly between ages 75 and 85 — and often with more pronounced diastolic dysfunction and autonomic involvement. This gender-specific timing and symptom profile underscores why tailored awareness is essential.

Practical Steps You Can Take Today

You don’t need to wait for symptoms to worsen — proactive, informed action makes a real difference.

Lifestyle considerations:

• Prioritize consistent, moderate activity — like daily walking or seated resistance exercises — to support circulation and muscle tone without overexertion. Avoid heavy lifting or straining, which can temporarily raise cardiac filling pressures.
• Stay well-hydrated, especially if you experience lightheadedness upon standing — a sign of possible autonomic involvement.
• Limit salt intake to ≤1,500 mg/day to help reduce fluid retention, particularly if swelling (edema) or shortness of breath develops.
• Review all medications with your doctor — some drugs (e.g., NSAIDs, certain antihypertensives) may require adjustment in the setting of infiltrative heart disease.

Self-monitoring tips:

• Keep track of daily energy levels using simple categories: “good,” “moderate,” or “low” — note trends over weeks, not days.
• Monitor for new or worsening symptoms: increasing shortness of breath with minimal activity, nighttime cough or wheezing, swelling in ankles or abdomen, or episodes of palpitations or near-fainting.
• Weigh yourself at the same time each morning — a sudden gain of ≥4 pounds in 3 days may signal fluid retention.
  Tracking your blood pressure trends can help you and your doctor make better decisions. Consider keeping a daily log or using a monitoring tool to stay informed.

When to see a doctor promptly:

• New or worsening shortness of breath at rest
• Fainting or near-fainting (syncope or presyncope)
• Chest discomfort that doesn’t improve with rest
• Rapid, unexplained weight gain (≥4 lbs in 3 days)
• Persistent, unrelenting fatigue interfering with daily life for more than 4–6 weeks

Early referral to a cardiologist experienced in amyloidosis — ideally one affiliated with an amyloid center — improves outcomes significantly. Disease-modifying therapies like tafamidis are now FDA-approved and shown to slow functional decline and reduce hospitalizations when started early.

A Reassuring Note on Heart Health and Next Steps

Cardiac amyloidosis symptoms women 73+ may sound daunting, but increased awareness, improved diagnostics, and newly available treatments mean this is no longer a condition to fear — but one to recognize, evaluate, and manage proactively. With timely intervention, many individuals maintain meaningful quality of life for years. If you're unsure, talking to your doctor is always a good idea.

FAQ

#### What are the most common cardiac amyloidosis symptoms women 73+ experience?

The most common symptoms include persistent, unexplained fatigue (often described as “heavy” or “washed out”), bilateral carpal tunnel syndrome (frequently requiring surgery in both wrists), shortness of breath with minimal exertion, leg or abdominal swelling, and lightheadedness upon standing. Notably, many women retain normal ejection fraction on echocardiogram — making symptoms the primary clue.

#### Can cardiac amyloidosis symptoms women 73+ be mistaken for other conditions?

Yes — very commonly. These symptoms are often misattributed to aging, osteoarthritis, depression, chronic fatigue syndrome, or “just being out of shape.” Bilateral carpal tunnel, in particular, is rarely linked to heart disease in routine care — yet it’s one of the strongest early predictors of ATTR amyloidosis in older women.

#### How is cardiac amyloidosis diagnosed in women over 73?

Diagnosis typically begins with a detailed history and physical exam, followed by ECG (looking for low voltage + pseudo-infarct), echocardiogram (assessing wall thickness and strain), and blood tests (BNP/NT-proBNP, serum free light chains). If suspicion remains, a technetium-99m PYP scan is performed — a non-invasive, highly accurate test that avoids the need for biopsy in most cases.

#### Is cardiac amyloidosis hereditary in older women?

Most cases in women over 73 are due to wild-type transthyretin amyloidosis (ATTRwt), which is not inherited and results from age-related misfolding of normal transthyretin protein. Hereditary ATTR (ATTRv) is much rarer in this age group and usually presents earlier (50s–60s) with family history and neuropathy. Genetic testing helps clarify the type.

#### Are there treatments for cardiac amyloidosis in older adults?

Yes — and they’re more effective when started early. Tafamidis, a stabilizer of the transthyretin protein, is FDA-approved for ATTR cardiomyopathy and shown to reduce cardiovascular hospitalizations and slow functional decline. Supportive care (e.g., diuretics for fluid control, pacemakers for conduction disease) remains important, and multidisciplinary care involving cardiology, neurology, and primary care yields the best outcomes.