Wild-type (senile) amyloidosis medical therapy: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 11: | Line 11: | ||
* Supportive treatment is with [[Diuretic|diuretics]], [[antiarrhythmics]] or [[pacemaker]] implantation, [[Anticoagulant|anticoagulation]] where [[supraventricular arrhythmias]] are present, and an avoidance of [[digoxin]] and [[Calcium channel blocker|calcium channel blockers]]. | * Supportive treatment is with [[Diuretic|diuretics]], [[antiarrhythmics]] or [[pacemaker]] implantation, [[Anticoagulant|anticoagulation]] where [[supraventricular arrhythmias]] are present, and an avoidance of [[digoxin]] and [[Calcium channel blocker|calcium channel blockers]]. | ||
*[[Antihypertensives]] are usually poorly tolerated as these patients can be profoundly [[Hypotension|hypotensive]]. | *[[Antihypertensives]] are usually poorly tolerated as these patients can be profoundly [[Hypotension|hypotensive]]. | ||
*For some [[Patient|patients]] with severe wild-type (senile) | *For some [[Patient|patients]] with severe wild-type (senile) amyloidosis, [[heart transplant]] may be the best option. | ||
* | *[[Pharmacological|Pharmacologic]] [[Therapy|therapies]] aimed at stabilizing the [[transthyretin]] [[molecule]] and thus preventing [[amyloid]] formation are being actively investigated. | ||
*In patients with transthyretin amyloid cardiomyopathy, Tafamidis was associated with reductions in all-cause mortality and cardiovascular-related hospitalizations and reduced the decline in functional capacity and quality of life as compared with placebo.<ref name="pmid30145929">{{cite journal| author=Maurer MS, Schwartz JH, Gundapaneni B, Elliott PM, Merlini G, Waddington-Cruz M et al.| title=Tafamidis Treatment for Patients with Transthyretin Amyloid Cardiomyopathy. | journal=N Engl J Med | year= 2018 | volume= 379 | issue= 11 | pages= 1007-1016 | pmid=30145929 | doi=10.1056/NEJMoa1805689 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30145929 }}</ref> | *In patients with transthyretin amyloid cardiomyopathy, Tafamidis was associated with reductions in all-cause mortality and cardiovascular-related hospitalizations and reduced the decline in functional capacity and quality of life as compared with placebo.<ref name="pmid30145929">{{cite journal| author=Maurer MS, Schwartz JH, Gundapaneni B, Elliott PM, Merlini G, Waddington-Cruz M et al.| title=Tafamidis Treatment for Patients with Transthyretin Amyloid Cardiomyopathy. | journal=N Engl J Med | year= 2018 | volume= 379 | issue= 11 | pages= 1007-1016 | pmid=30145929 | doi=10.1056/NEJMoa1805689 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30145929 }}</ref> | ||
Revision as of 19:59, 19 December 2019
|
Wild-type (senile) amyloidosis Microchapters |
|
Differentiating Wild-type (senile) amyloidosis from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Wild-type (senile) amyloidosis medical therapy On the Web |
|
American Roentgen Ray Society Images of Wild-type (senile) amyloidosis medical therapy |
|
Risk calculators and risk factors for Wild-type (senile) amyloidosis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2]
Overview
Medical Therapy
- There is no treatment for wild-type (senile) amyloidosis; the mainstay of therapy is supportive treatment aimed at symptoms of the disease.
- Since wild-type (senile) amyloidosis commonly presents with symptoms of right-sided heart failure and carpal tunnel syndrome, treating amyloid deposits in the heart is important.[1]
- Supportive treatment is with diuretics, antiarrhythmics or pacemaker implantation, anticoagulation where supraventricular arrhythmias are present, and an avoidance of digoxin and calcium channel blockers.
- Antihypertensives are usually poorly tolerated as these patients can be profoundly hypotensive.
- For some patients with severe wild-type (senile) amyloidosis, heart transplant may be the best option.
- Pharmacologic therapies aimed at stabilizing the transthyretin molecule and thus preventing amyloid formation are being actively investigated.
- In patients with transthyretin amyloid cardiomyopathy, Tafamidis was associated with reductions in all-cause mortality and cardiovascular-related hospitalizations and reduced the decline in functional capacity and quality of life as compared with placebo.[2]
References
- ↑ Tanskanen M, Peuralinna T, Polvikoski T, Notkola IL, Sulkava R, Hardy J; et al. (2008). "Senile systemic amyloidosis affects 25% of the very aged and associates with genetic variation in alpha2-macroglobulin and tau: a population-based autopsy study". Ann Med. 40 (3): 232–9. doi:10.1080/07853890701842988. PMID 18382889.
- ↑ Maurer MS, Schwartz JH, Gundapaneni B, Elliott PM, Merlini G, Waddington-Cruz M; et al. (2018). "Tafamidis Treatment for Patients with Transthyretin Amyloid Cardiomyopathy". N Engl J Med. 379 (11): 1007–1016. doi:10.1056/NEJMoa1805689. PMID 30145929.