Cardiac Amyloid

This infographic provides a comprehensive overview of cardiac amyloidosis, detailing its cardiac and extra-cardiac manifestations, diagnostic work-up, staging, and management options.

• Manifestations
  • Cardiac: Includes microvascular ischemia, ventricular thickening, abnormal P-waves, atrial arrhythmias, conduction disease, and pericardial effusion.
  • Extra-cardiac:
    • AL Amyloid: Symptoms include periorbital edema, macroglossia, and nephrotic syndrome.
    • TTR Amyloid: Often involves neuropathy, spontaneous tendon rupture, and lumbar spinal stenosis.
• Work-Up and Diagnosis
  • Labs: Check for serum kappa/lambda light chains and conduct immunofixation to identify AL amyloid.
  • Imaging: Key tools include TTE with strain imaging, nuclear scans, and cardiac MRI to assess diffuse subendocardial involvement.
  • Staging: Uses Mayo staging criteria for AL cardiac amyloid, which assess troponin, NT-proBNP levels, and serum free light chains.
• Management
  • AL Amyloid: Managed with chemotherapy, stem cell transplantation, or heart transplant.
  • TTR Amyloid: Treatment options include tafamidis, diflunisal, and organ transplantation (heart/liver). Additionally, patisiran or inotersen may be used for ATTR neuropathy.
• Clinical Presentation and Physical Exam
  • Patients may experience exertional dyspnea, syncope, edema, and peripheral neuropathy.
  • Physical findings such as macroglossia, periorbital bruising, and Kussmaul’s sign are often present, particularly in AL amyloid cases.
• EKG Findings
  • Key signs include low voltage, pseudo-infarct patterns, and conduction disease. Atrial fibrillation is common, necessitating anticoagulation for stroke prevention.

This infographic provides an excellent guide for diagnosing and managing cardiac amyloidosis, emphasizing the importance of timely diagnosis to prevent complications.

Produced by Dr. Carine Hamo

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