Cardiac amyloidosis electrocardiogram
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]; Aarti Narayan, M.B.B.S [3]; Cafer Zorkun, M.D., Ph.D. [4]
Overview
The combination of low voltage electrocardiographic pattern and increased thickness of the left ventricular posterior wall and interventricular septum on echocardiogram is highly specific for cardiac amyloidosis. Cardiac conduction and rhythm disturbances are common in cardiac amyloidosis, however, direct infiltration of the specialized conduction tissue of the heart by the amyloid may not account for the majority of these disturbances.
Electrocardiogram
Electrocardiographic findings in cardiac amyloidosis include:[1][2][3]
- Low voltage complexes
- Pseudo-infarct pattern of poor R wave progression
- Left ventricular hypertrophy on electrocardiogram
- Higher degree AV blocks
- Bundle branch blocks: Left bundle branch block is seen in 40% of the patients with wild-type ATTR versus 4% of those with AL amyloid type.
- AV nodal slowing of heart rate
- Arrhythmias such as
Lack of variability in the heart rate due to autonomic dysfunction can be found on Holter monitoring. This lack of variability is an important predictor of 1-year mortality in these patients.[4] This lack of variability in the heart rate was shown to be a consistent predictive parameter of short-term mortality in patients with AL type cardiac amyloidosis compared to those with AA type.
References
- ↑ Ridolfi RL, Bulkley BH, Hutchins GM (1977). "The conduction system in cardiac amyloidosis. Clinical and pathologic features of 23 patients". The American Journal of Medicine. 62 (5): 677–86. PMID 871125. Unknown parameter
|month=ignored (help) - ↑ Rahman JE, Helou EF, Gelzer-Bell R; et al. (2004). "Noninvasive diagnosis of biopsy-proven cardiac amyloidosis". Journal of the American College of Cardiology. 43 (3): 410–5. doi:10.1016/j.jacc.2003.08.043. PMID 15013123. Unknown parameter
|month=ignored (help) - ↑ Murtagh B, Hammill SC, Gertz MA, Kyle RA, Tajik AJ, Grogan M (2005). "Electrocardiographic findings in primary systemic amyloidosis and biopsy-proven cardiac involvement". The American Journal of Cardiology. 95 (4): 535–7. doi:10.1016/j.amjcard.2004.10.028. PMID 15695149. Unknown parameter
|month=ignored (help) - ↑ Reyners AK, Hazenberg BP, Reitsma WD, Smit AJ (2002). "Heart rate variability as a predictor of mortality in patients with AA and AL amyloidosis". European Heart Journal. 23 (2): 157–61. doi:10.1053/euhj.2001.2972. PMID 11785998. Unknown parameter
|month=ignored (help)