When do you initiate migalastat in female patients with genetic evidence of heterozygous Fabry disease?  

Female "carriers" of a Fabry gene mutation should be offered treatment when there is clinical or subclinical evidence of cardiac, neurologic, renal, or GI involvement. This means that all female heterozygotes need a clinical exam, echo, EKG +/- Holter, creatinine, urine protein/creatinine ratio, neu...