“Popeye Arms” & Hypertensive Heart Disease

On December 4, 2019 I blogged about a patient of mine who had had bilateral biceps tendon ruptures and carried the diagnosis of hypertrophic cardiomyopathy. A technesium pyrophophate scan documented that he had cardiac amyloidosis. I was catching up on some old JAMA-Cardiology issues when I found this great picture of “popeye arms” in a patient with what was thought to have hypertensive heart disease because he had long-standing hypertension, mild left ventricular hypertrophy, and heart failure with preserved ejection fraction. These are bilateral biceps tendon ruptures, and this patient also had cardiac amyloidosis. We need to remember, and to remind our orthopedic friends, that transthyretin amyloidosis can present with biceps tendon ruptures, carpal tunnel symptoms, and palmar tendon nodules (see my “Be a Palm Reader” blog from January 18, 2020) often long before the cardiac amyloidosis become obvious.