Cardiological Care

Treatment for amyloid cardiopathies essentially consists of diuretic therapy and restricting the amount of sodium in the diet relative to congestion levels. Beta-blockers and bradycardia treatments are not recommended. Raising the heart-rate is the only way to maintain the heart’s output (cardiac output = heart rate x stroke volume), as the myocardial walls are stiff due to myocardial infiltration, preventing any increase in ejection volume (stroke volume = end-diastolic volume – end-systolic volume). Medications which have negative dromotropic effects are not advised as they can aggravate conduction disorders.

Doctors must be wary of hypotensive treatments for patients with amyloidosis as they can trigger dysautonomia and lead to falls.

Arrhythmias are common and it is often necessary to use antiarrhythmic drugs. Amiodarone is the usual medication of choice to maintain sinus rhythm in paroxysmal atrial fibrillation. It is normally not advised to use digoxin to treat arrhythmias because of its potential toxic effects. Screening for conduction disorders must also be carried out, first with an ECG and then using a Holter monitor. An endocardial examination investigating prolonged Infra-Hisian conduction time (measurement of HV) might also be necessary. Due to the high risk that patients will develop a conduction disorder, pacemakers are often implanted as soon as anomalies start to show.

The risk of embolism is high, particularly when the atria have been infiltrated (detectable by MRI) because they lose their contractile activity, despite the fact that their electrical activity is normal, namely in sinus rhythm.