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Cardiac amyloidosis

Amyloidosis - cardiac; Primary cardiac amyloidosis - AL type; Secondary cardiac amyloidosis - AA type; Stiff heart syndrome; Senile amyloidosis

 

Cardiac amyloidosis is a disorder caused by deposits of an abnormal protein (amyloid) in the heart tissue. These deposits make it hard for the heart to work properly.

Causes

 

Amyloidosis is a group of diseases in which clumps of proteins called amyloids build up in body tissues. Over time, these proteins replace normal tissue, leading to failure of the involved organ. There are many forms of amyloidosis.

Cardiac amyloidosis ("stiff heart syndrome") occurs when amyloid deposits take the place of normal heart muscle. It is the most typical type of restrictive cardiomyopathy. Cardiac amyloidosis may affect the way electrical signals move through the heart (conduction system). This can lead to abnormal heartbeats (arrhythmias) and faulty heart signals (heart block).

The condition can be inherited. This is called familial cardiac amyloidosis. It can also develop as the result of another disease such as a type of bone and blood cancer, or as the result of another medical problem causing inflammation. Cardiac amyloidosis is more common in men than in women. The disease is rare in people under age 40.

 

Symptoms

 

Some people may have no symptoms. When present, symptoms may include:

  • Excessive urination at night
  • Fatigue, reduced exercise ability
  • Palpitations (sensation of feeling heartbeat)
  • Shortness of breath with activity
  • Swelling of the abdomen, legs, ankles, or other part of the body
  • Trouble breathing while lying down

 

Exams and Tests

 

The signs of cardiac amyloidosis can be related to a number of different conditions. This can make the problem hard to diagnose.

Signs may include:

  • Abnormal sounds in the lung (lung crackles) or a heart murmur
  • Blood pressure that is low or drops when you stand up
  • Enlarged neck veins
  • Swollen liver

The following tests may be done:

  • Chest or abdomen CT scan (considered the "gold standard" to help diagnose this condition)
  • Coronary angiography
  • Electrocardiogram (ECG)
  • Echocardiogram
  • Magnetic resonance imaging (MRI)
  • Nuclear heart scans (MUGA, RNV)
  • Positron emission tomography (PET)

An ECG may show problems with the heartbeat or heart signals. It may also show low signals (called “low voltage”).

A cardiac biopsy is used to confirm the diagnosis. A biopsy of another area, such as the abdomen, kidney, or bone marrow, is often done as well.

 

Treatment

 

Your health care provider may tell you to make changes to your diet, including limiting salt and fluids.

You may need to take water pills (diuretics) to help your body get rid of excess fluid. The provider may tell you to weigh yourself every day. A weight gain of 3 or more pounds (1 kilogram or more) over 1 to 2 days can mean there is too much fluid in the body.

Medicines including digoxin, calcium-channel blockers, and beta-blockers may be used in people with atrial fibrillation. However, the drugs must be used with caution, and the dosage must be carefully monitored. People with cardiac amyloidosis may be extra sensitive to side effects of these drugs.

Other treatments may include:

  • Chemotherapy
  • Implantable cardioverter-defibrillator (AICD)
  • Pacemaker, if there are problems with heart signals
  • Prednisone, an anti-inflammatory medicine

A heart transplant may be considered for people with some types of amyloidosis who have very poor heart function. People with hereditary amyloidosis may need a liver transplant.

 

Outlook (Prognosis)

 

In the past, cardiac amyloidosis was thought to be an untreatable and rapidly fatal disease. However, the field is changing rapidly. Different types of amyloidosis can affect the heart in different ways. Some types are more severe than others. Many people can now expect to survive and experience a good quality of life for several years after diagnosis.

 

Possible Complications

 

Complications may include:

  • Atrial fibrillation or ventricular arrhythmias
  • Congestive heart failure
  • Fluid buildup in the abdomen (ascites)
  • Increased sensitivity to digoxin
  • Low blood pressure and dizziness from excessive urination (due to medicine)
  • Sick sinus syndrome
  • Symptomatic cardiac conduction system disease (arrhythmias related to abnormal conduction of impulses through the heart muscle)

 

When to Contact a Medical Professional

 

Call your provider if you have this disorder and develop new symptoms such as:

  • Dizziness when you change position
  • Excessive weight (fluid) gain
  • Excessive weight loss
  • Fainting spells
  • Severe breathing problems

 

 

References

McKenna W, Elliott P. Diseases of the myocardium and endocardium. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 60.

Warnes CA. Pregnancy and heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 78.

 
  • Nuclear heart scan overview

    Nuclear heart scan overview

    Animation

  •  

    Nuclear heart scan overview - Animation

    How a nuclear heart scan works and what it can tell your doctor about the health of your heart.

  • Heart, section through the middle

    Heart, section through the middle - illustration

    The interior of the heart is composed of valves, chambers, and associated vessels.

    Heart, section through the middle

    illustration

  • Dilated cardiomyopathy

    Dilated cardiomyopathy - illustration

    Dilated cardiomyopathy involves enlargement of the heart muscle and is the most common type of cardiomyopathy. The heart muscle is weakened and cannot pump blood efficiently. Decreased heart function affects the lungs, liver, and other body systems.

    Dilated cardiomyopathy

    illustration

  • Biopsy catheter

    Biopsy catheter - illustration

    When a small piece of heart muscle tissue is needed for examination, a heart biopsy can be performed. A catheter is carefully threaded into an artery or vein to gain access into the heart. A bioptome (catheter with jaws in its tip) is then introduced. Once the bioptome is in place, three to five small pieces of tissue from the heart muscle are removed. The test is performed routinely after heart transplantation to detect potential rejection. It may also be performed when cardiomyopathy, myocarditis, cardiac amyloidosis, or other disorders are suspected.

    Biopsy catheter

    illustration

  • Nuclear heart scan overview

    Animation

  •  

    Nuclear heart scan overview - Animation

    How a nuclear heart scan works and what it can tell your doctor about the health of your heart.

  • Heart, section through the middle

    Heart, section through the middle - illustration

    The interior of the heart is composed of valves, chambers, and associated vessels.

    Heart, section through the middle

    illustration

  • Dilated cardiomyopathy

    Dilated cardiomyopathy - illustration

    Dilated cardiomyopathy involves enlargement of the heart muscle and is the most common type of cardiomyopathy. The heart muscle is weakened and cannot pump blood efficiently. Decreased heart function affects the lungs, liver, and other body systems.

    Dilated cardiomyopathy

    illustration

  • Biopsy catheter

    Biopsy catheter - illustration

    When a small piece of heart muscle tissue is needed for examination, a heart biopsy can be performed. A catheter is carefully threaded into an artery or vein to gain access into the heart. A bioptome (catheter with jaws in its tip) is then introduced. Once the bioptome is in place, three to five small pieces of tissue from the heart muscle are removed. The test is performed routinely after heart transplantation to detect potential rejection. It may also be performed when cardiomyopathy, myocarditis, cardiac amyloidosis, or other disorders are suspected.

    Biopsy catheter

    illustration

A Closer Look

 

    Self Care

     

      Tests for Cardiac amyloidosis

       

       

      Review Date: 5/5/2016

      Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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