Cardiac amyloidosis natural history, complications and prognosis

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

Overview

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

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). For primary amyloidosis, the median survival after diagnosis is about 2.1 years.

Complications

• Congestive heart failure
• Atrial fibrillation or ventricular arrhythmias
• Sick sinus syndrome (occasionally)
• Symptomatic cardiac conduction system disease (arrhythmias related to abnormal conduction of impulses through the heart muscle)
• Low blood pressure and dizziness from excessive urination (from medication)
• 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)

References

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