Wild-type (senile) amyloidosis electrocardiogram: Difference between revisions

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==Electrocardiogram==
==Electrocardiogram==
*The EKG findings in wild-type (senile) amyloidosis have low sensitivity and specificity for the condition.<ref>{{Cite journal
| author = [[Ilia G. Halatchev]], [[Jingsheng Zheng]] & [[Jiafu Ou]]
| title = Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA), previously known as senile cardiac amyloidosis: clinical presentation, diagnosis, management and emerging therapies
| journal = [[Journal of thoracic disease]]
| volume = 10
| issue = 3
| pages = 2034–2045
| year = 2018
| month = March
| doi = 10.21037/jtd.2018.03.134
| pmid = 29707360
}}</ref>
*This is because the EKG findings are also common in aging patients in the setting of comorbidities.


* EKG is one of the oldest, best described and most widely used cardiac diagnostic modalities worldwide. However, its use as diagnostic tool for ATTRwt-CA has likely lead to falsely reduced clinical suspicion and its underdiagnoses of the disease.
* This is largely from the “classical” teaching which dictates that cardiac amyloidosis is associated with low voltage
* In recent ATTRwt-CA studies, low voltage has been found to have poor independent sensitivity (~30%) for its diagnosis.
* There are numerous other EKG findings that are seen in patients with ATTRwt-CA but have low sensitivity and specificity for the disease because they are also common in age and comorbidities matched patient cohorts:
** Pseudoinfarct pattern
** Poor R-wave progression
** Atrial fibrillation
** First degree AV block
** Nonspecific ST-T-wave abnormalities
** Left bundle branch block can be potentially useful to differentiate ATTRwt-CA and AL-CA.
* Voltage-to-mass ratio, calculated by sum of S wave in lead V1 plus R wave in lead V5 or V6 (SV1 + RV5 or V6) divided by the echocardiographic muscle cross-sectional area has been shown to have high sensitivity and specificity for ATTRwt-CA.


==References==
==References==

Revision as of 22:13, 17 December 2019

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Overview

Electrocardiogram

  • The EKG findings in wild-type (senile) amyloidosis have low sensitivity and specificity for the condition.[1]
  • This is because the EKG findings are also common in aging patients in the setting of comorbidities.


References

  1. ↑ Ilia G. Halatchev, Jingsheng Zheng & Jiafu Ou (2018). "Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA), previously known as senile cardiac amyloidosis: clinical presentation, diagnosis, management and emerging therapies". Journal of thoracic disease. 10 (3): 2034–2045. doi:10.21037/jtd.2018.03.134. PMID 29707360. Unknown parameter |month= ignored (help)
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