Speckled pattern in transthoracic echocardiogram: with the advent of harmonic imaging, this is a feature of cardiac amyloidosis that is less reliable due to augmentation of speckles in myocardium and can be seen in harmonic imaging mode. Speckled pattern in transthoracic echocardiogram: with the advent of harmonic imaging, this is a feature of cardiac amyloidosis that is less reliable due to augmentation of speckles in myocardium and can be seen in harmonic imaging mode. In some echo laboratories, a frame of PLAX using fundamental imaging will be acquired on suspicion. This is a qualitative assessment and should not be used by itself to diagnose cardiac amyloidosis. LA, left atrium; LV, left ventricle; RV, right ventricle. Ali M Agha et al. Open Heart 2018;5:e000881 ©2018 by British Cardiovascular Society