Cardiac amyloidosis medical therapy

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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]; Lakshmi Gopalakrishnan, M.B.B.S. [5]

Overview

Diuretics and angiotensin-converting inhibitors are the standard therapy regimen to treat congestive heart failure secondary to cardiac amyloidosis. However, presence of hypotension may limit the use of diuretics

Digoxin and calcium channel blockers bind to the amyloid fibrils and thereby have been reported to increase the incidence of congestive heart failure and produce arrhythmias. Hence, these drugs may be avoided in patients with both AL and TTR cardiac amyloidosis.^[1]^[2]^[3]

Physical activity may continue as long as the patient can tolerate it.

Diet restrictions vary with the extent of cardiomyopathy and heart failure. These may include salt and/or fluid restrictions.

Diuretics (water pills) may be given to remove excess fluid.

Digoxin may be used cautiously to improve heart control in patients with atrial fibrillation.

Daily weight measurement may be recommended. A weight gain of 3 or 4 pounds or more over 1 or 2 days can indicate excessive fluid accumulation.

Some people benefit from chemotherapy or prednisone.

A pacemaker may be needed if the conduction system is involved.

↑ Gertz MA, Skinner M, Connors LH, Falk RH, Cohen AS, Kyle RA (1985). "Selective binding of nifedipine to amyloid fibrils". The American Journal of Cardiology. 55 (13 Pt 1): 1646. PMID 4003315. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ Gertz MA, Falk RH, Skinner M, Cohen AS, Kyle RA (1985). "Worsening of congestive heart failure in amyloid heart disease treated by calcium channel-blocking agents". The American Journal of Cardiology. 55 (13 Pt 1): 1645. PMID 4003314. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ Rubinow A, Skinner M, Cohen AS (1981). "Digoxin sensitivity in amyloid cardiomyopathy". Circulation. 63 (6): 1285–8. PMID 7014028. Retrieved 2012-02-13. Unknown parameter |month= ignored (help)
↑ Mathew V, Olson LJ, Gertz MA, Hayes DL (1997). "Symptomatic conduction system disease in cardiac amyloidosis". The American Journal of Cardiology. 80 (11): 1491–2. PMID 9399732. Retrieved 2012-02-13. Unknown parameter |month= ignored (help)
↑ Mathew V, Chaliki H, Nishimura RA (1997). "Atrioventricular sequential pacing in cardiac amyloidosis: an acute Doppler echocardiographic and catheterization hemodynamic study". Clinical Cardiology. 20 (8): 723–5. PMID 9259166. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)