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ClearRounds Health · Cardiology · Quick Reference

Cardiac Amyloidosis

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Heart Failure & CardiomyopathyAdvancedIn progressOne-page PDF

When to suspect, red flags, echo/ECG clues, PYP scan pathway, light chain exclusion, and referral.

Last reviewed

Pending initial clinical review

Sources / guidelines to verify

  • 2023 ACC ECDP on Cardiac Amyloidosis
  • ASNC/AHA Multimodality Imaging for Cardiac Amyloidosis
Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.

One-page reference

Draft content pending the site owner’s clinical review. Verify against the sources above and local protocol before clinical use.

1

What it is / why it matters

  • Misfolded-protein deposition (ATTR or AL) causing an infiltrative/restrictive cardiomyopathy.
  • ATTR is increasingly treatable; AL is a hematologic emergency — the distinction is everything.
2

Key diagnostic clues

  • HFpEF with thick walls but LOW ECG voltage (discordance).
  • Bilateral carpal tunnel, spinal stenosis, peripheral neuropathy.
  • Intolerance of beta-blockers/ACEi (low BP); echo apical sparing on strain.
  • AL clues: nephrotic-range proteinuria, macroglossia, easy bruising.
3

Initial workup

Order matters

  • RULE OUT AL FIRST — serum/urine free light chains + immunofixation. Only if negative is a 99mTc-PYP/DPD scan (grade 2–3 = ATTR) valid.
  • Echo (thick walls, granular texture, apical sparing), ECG (low voltage, pseudoinfarct), genetic testing (hereditary vs wild-type ATTR).
4

Management framework

  • ATTR: tafamidis and newer stabilizers/silencers via specialist.
  • AL: urgent hematology/oncology referral for chemotherapy.
  • Cautious diuretics; many standard HF agents are poorly tolerated.
  • Anticoagulate AF even at low CHA₂DS₂-VASc (high thrombus/stroke risk).
5

Red flags / escalate now

  • Suspected AL amyloid — rapidly progressive; do NOT delay hematology referral.
  • Advanced heart failure, conduction disease, or arrhythmia.
6

Follow-up / monitoring

  • Specialist co-management; monitor volume and arrhythmia.
7

Clinic pearls

  • Think amyloid in HFpEF with thick walls + low voltage + carpal tunnel.
  • Always exclude AL (light chains) before calling it ATTR — the PYP scan is only valid after that.

Related quick references

📄 Cardiomyopathy Overview: Dilated, Hypertrophic, Restrictive📄 HFpEF

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ClearRounds Health · Cardiology — Cardiac Amyloidosis Quick Reference · Last reviewed: Pending initial clinical review · Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.