Cardiac amyloidosis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]; Cafer Zorkun, M.D., Ph.D. [4]; Lakshmi Gopalakrishnan, M.B.B.S. [5]

Overview

The presence or absence of cardiac involvement with amyloid is the most important prognostic factor.

Complications

• Congestive heart failure
• Sudden cardiac death
• Myocardial infarction
• Atrial fibrillation
• Tachyarrhythmias
• Ventricular arrhythmias
• Sick sinus syndrome (occasionally)
• Heart blocks and other conduction defects
• Syncope or presyncope
• Increased sensitivity to digoxin with the potential for digoxin toxicity and related arrhythmias. The amyloid protein tends to bind the digoxin and increase its local concentration in the conduction system for instance.
• Ascites (fluid accumulation in the abdomen)
• Cardiac tamponade
• Stroke and claudication due to intracardiac thrombus causing thromboembolism.

Prognosis

Cardiac amyloidosis is a chronic and progressive condition. A cardiologist may estimate the prognosis according to the thickness of the left ventricle and to the degree of restriction in the heart (diastolic dysfunction).

References

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