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[Cardiac amyloidosis]
S Nobuoka1, S Hatano, J Nagashima
1Division of Cardiology, St. Marianna University School of Medicine.
Insights
Cardiac amyloidosis often presents with specific electrocardiogram and imaging findings, including poor R wave progression and left ventricular thickening. These indicators suggest suspecting cardiac amyloidosis in unexplained chronic heart failure cases.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Electrophysiology
Context:
- Cardiac amyloidosis is a progressive condition often diagnosed late.
- Early identification is crucial for managing chronic heart failure of unknown etiology.
- Diagnostic challenges exist due to non-specific clinical presentations.
Purpose:
- To identify frequently observed diagnostic findings in cardiac amyloidosis.
- To highlight the utility of echocardiography in predicting prognosis.
- To emphasize the importance of suspecting cardiac amyloidosis in specific clinical scenarios.
Summary:
- Electrocardiogram (ECG) commonly shows QS pattern and atrio-ventricular block.
- Chest X-ray may reveal cardiomegaly with pleural effusion.
- Echocardiography often demonstrates left ventricular thickening, pericardial effusion, and diastolic dysfunction.
- Cardiac catheterization can indicate increased right ventricular end-diastolic pressure.
- Left ventricular mass via echocardiography is a potential prognostic marker.
Impact:
- Facilitates earlier suspicion and diagnosis of cardiac amyloidosis.
- Improves patient management strategies for unexplained chronic heart failure.
- Enhances prognostic assessment using echocardiographic parameters.
- Contributes to a better understanding of the diagnostic profile of cardiac amyloidosis.
Abstract:
In our experience, QS pattern of poor R wave progression and atrio-ventricular block of varying degrees on electrocardiogram, cardiomegaly with pleural effusion on chest X-ray film, left ventricular wall thickening, pericardial effusion and findings suggesting left ventricular diastolic dysfunction on echocardiogram and increased right ventricular end-diastolic pressure in cardiac catheterization were frequently observed in patients with cardiac amyloidosis. Though none of these findings are specific, we should suspect cardiac amyloidosis as a possibility when some of these signs are observed in patients with chronic cardiac failure of unknown etiology. Left ventricular mass obtained from echocardiography could be useful predictive parameter of prognosis in patients with cardiac amyloidosis.