Dr Rodney Falk analyses an echocardiogram showing mild mitral stenosis, moderate mitral regurgitation and moderate prosthetic valve dysfunction. The mitral valve is thickened with restricted posterior leaflet motion and the left ventricular walls are moderately thickened, raising the question of hypertrophy versus amyloid infiltration. Strain imaging (-12.2) shows a pattern typical of cardiac amyloidosis. A positive PYP scan with no monoclonal gammopathy confirms the diagnosis, highlighting the
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