{"id":2827,"date":"2021-02-19T08:26:05","date_gmt":"2021-02-19T08:26:05","guid":{"rendered":"https:\/\/www.reseau-amylose.org\/jesuissoignant\/?page_id=2827"},"modified":"2025-01-16T14:35:11","modified_gmt":"2025-01-16T13:35:11","slug":"pour-le-geriatre","status":"publish","type":"page","link":"https:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-geriatre\/","title":{"rendered":"Pour le G\u00e9riatre"},"content":{"rendered":"\t\t
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D\u00e9pister, diagnostiquer et prendre en charge les amylose cardiaques<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Insuffisance cardiaque et amylose\u00a0<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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L\u2019insuffisance cardiaque (IC) est le premier motif d\u2019hospitalisation en Unit\u00e9 de G\u00e9riatrie Aigu\u00eb. Les G\u00e9riatres sont donc en premi\u00e8re ligne avec les cardiologues dans la prise en charge de l\u2019insuffisance cardiaque du sujet \u00e2g\u00e9. l\u2019IC \u00e0 Fraction d\u2019\u00e9jection pr\u00e9serv\u00e9e est la forme la plus fr\u00e9quente dans cette population.<\/em><\/strong><\/span><\/h6>
Parmi ces patients 15 \u00e0 20 % ont peut-\u00eatre une AMYLOSE CARDIAQUE (AC).<\/u><\/em><\/strong><\/span>\u00a0<\/strong><\/span><\/h6>
Les amyloses cardiaques<\/strong> (AC) sont sous-diagnostiqu\u00e9es. Il s\u2019agit de maladies syst\u00e9miques caract\u00e9ris\u00e9es par l\u2019accumulation de prot\u00e9ines sous forme de \u00ab\u00a0fibrilles amylo\u00efdes\u00a0\u00bb dans diff\u00e9rents organes tels que le c\u0153ur, le rein, le foie, le syst\u00e8me gastro-intestinal et nerveux, provoquant ainsi l\u2019alt\u00e9ration structurelle et la dysfonction des organes atteints.<\/span><\/h6>
Les principaux types d\u2019AC atteignant le c\u0153ur du sujet \u00e2g\u00e9 sont\u00a0:<\/span><\/h6>
\u00a0 \u00a0 – l\u2019amylose \u00e0 Transthyr\u00e9tine (ATTR) sauvage aussi appel\u00e9e \u00abs\u00e9nile\u00bb (ATTRwt pour wild-type)<\/span><\/h6>
\u00a0 \u00a0 – l\u2019amylose \u00e0 Transthyr\u00e9tine (ATTR) \u00ab h\u00e9r\u00e9ditaire \u00bb aussi appel\u00e9e \u00abmut\u00e9e\u00bb (ATTRv pour varient)<\/span><\/h6>
\u00a0 \u00a0 – l\u2019 amylose AL (maladie h\u00e9matologique)<\/span><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Figure : Cardiomyopathie hypertrophique<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Le diagnostic : quand y penser ?\u00a0<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Les signes cliniques d\u00e9pendent des organes touch\u00e9s.<\/span><\/h6>
Manifestations cardiaques\u00a0: <\/strong><\/span><\/h6>
\u00a0 \u00a0 – Insuffisance cardiaque \u00e0 FEVG pr\u00e9serv\u00e9e avec Hypertrophie Ventriculaire Gauche concentrique retrouv\u00e9e \u00e0 l\u2019ETT<\/span><\/h6>
\u00a0 \u00a0 – R\u00e9sistance aux traitements habituels de l\u2019IC, avec pouss\u00e9es it\u00e9ratives<\/span><\/h6>
\u00a0 \u00a0 – Microvoltage paradoxal \u00e0 l\u2019ECG<\/span><\/h6>
Manifestations ost\u00e9o articulaires :<\/strong><\/span><\/h6>
\u00a0 \u00a0 – Syndrome du canal carpien++<\/span><\/h6>
\u00a0 \u00a0 – Syndrome du Dupuytren<\/span><\/h6>
\u00a0 \u00a0 – Syndrome du canal lombaire \u00e9troit<\/span><\/h6>
\u00a0 \u00a0 – Rupture du tendon de l\u2019\u00e9paule et\/ou biceps<\/span><\/h6>
\u00a0 \u00a0 – L\u00e9sions ungu\u00e9ales<\/span><\/h6>
Manifestations neurosensorielles\u00a0:<\/strong><\/span><\/h6>
\u00a0 \u00a0 \u00a0– Neuropathie des extr\u00e9mit\u00e9s<\/span><\/h6>
\u00a0 \u00a0 \u00a0– Macroglossie<\/span><\/h6>
\u00a0 \u00a0 \u00a0– Dysautonomie (diarrh\u00e9es, vomissements)<\/span><\/h6>
\u00a0 \u00a0 \u00a0– Hypotension orthostatique<\/span><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Figure : Atteintes cardiaques et extracardiaques<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Amylose et fragilit\u00e9<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Les cons\u00e9quences des AC\u00a0pour les patients \u00e2g\u00e9s:<\/strong><\/span><\/h6>
\u00a0 \u00a0 –<\/em> Autonomie : 69% des patients en perte d\u2019ind\u00e9pendance fonctionnelle<\/span><\/h6>
\u00a0 \u00a0 – Neuro-Cognitives : Syndrome dysex\u00e9cutif (72%)<\/span><\/h6>
\u00a0 \u00a0 – Thymiques : Syndrome d\u00e9pressif (49%)<\/span><\/h6>
\u00a0 \u00a0 – Motrices : Faiblesse musculaire (74%), Troubles de la marche et de l\u2019\u00e9quilibre (58%), s\u00e9dentarit\u00e9 (47%), risque de chute (42%) et sarcop\u00e9nie<\/span><\/h6>
\u00a0 \u00a0 – Nutritionnelles : Anorexie, amaigrissement (31%), malnutrition (39%)<\/span><\/h6>
\u00a0 \u00a0 – Troubles v\u00e9sico sphynct\u00e9riens : Incontinence urinaire par Hyperactivit\u00e9 v\u00e9sicale<\/span><\/h6>
\u00a0 \u00a0 – Asth\u00e9nie (61%)<\/span><\/h6>
\u00a0<\/h6>
Les tests utilis\u00e9s pour l\u2019\u00e9valuation globale et le d\u00e9pistage de la fragilit\u00e9 dans le cadre de l\u2019Amylose Cardiaque :<\/strong><\/span><\/h6>
\u00a0 \u00a0 – Le score Short Emergency Geriatric Assessment <\/em>(SEGA) pour le d\u00e9pistage de la fragilit\u00e9 (non fragile: score \u2264 8; fragile et tr\u00e8s fragile: score> 8)<\/span><\/h6>
\u00a0 \u00a0 – Les \u00e9chelles ADL et IADL pour \u00e9valuer l’autonomie:<\/span><\/h6>
\u00a0 \u00a0 – Un bilan de d\u00e9brouillage cognitif avec notamment Mini-Mental State Examination (MMSE) et une \u00e9valuation des fonctions ex\u00e9cutive (BREF et Horloge)<\/span><\/h6>
\u00a0 \u00a0 – Evaluation de la d\u00e9pression avec l’\u00e9chelle Geriatric Depression Scale ( GDS ou mini-GDS ).<\/span><\/h6>
\u00a0 \u00a0 – Evaluation de la performance physique, de l\u2019\u00e9quilibre et de la force musculaire par le Short Physical Performance Battery (SPPB<\/span><\/h6>
\u00a0 \u00a0 – Le Mini Nutritional Assessment (MNA) pour \u00e9valuer l’\u00e9tat nutritionnel<\/span><\/h6>
\u00a0 \u00a0 – Evaluation des fonctions V\u00e9sico Sphynct\u00e9riennes par l\u2019Urinary Symptom Profile <\/em>(USP)<\/span><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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L'avis du g\u00e9riatre : le sujet \u00e2g\u00e9 - amylose et fragilit\u00e9<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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<\/div>\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Bilan de l'amylose<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Les examens \u00e0 demander en 1\u00e8re<\/sup> intention devant une suspicion d\u2019amylose cardiaque\u00a0:<\/strong><\/span><\/h6>
Le<\/strong> \u00a0bilan biologique\u00a0:<\/strong><\/span><\/h6>
\u00a0 \u00a0 – Biomarqueurs : NT-proBNP et troponine ultrasensible<\/span><\/h6>
\u00a0 \u00a0 – EPP, Immunofixation et dosage des Chaines l\u00e9g\u00e8res libres,<\/span><\/h6>
\u00a0 \u00a0 – Recherche de prot\u00e9inurie de Bence Jones<\/span><\/h6>
\u00a0 \u00a0 – Bilan h\u00e9patique et r\u00e9nal.<\/span><\/h6>
ECG\u00a0:<\/strong> Microvoltage, Troubles conductifs, Fibrillation auriculaire ou Flutter.<\/span><\/h6>
Echocardiographie\u00a0: examen central pour \u00e9voquer le diagnostic<\/strong><\/span><\/h6>
\u00a0 \u00a0 – Hypertrophie ventriculaire gauche circonf\u00e9rentielle,<\/span><\/h6>
\u00a0 \u00a0 – Alt\u00e9ration typique du strain (alt\u00e9r\u00e9 \u00e0 la base du VG, pr\u00e9serv\u00e9 \u00e0 l\u2019apex du VG)<\/span><\/h6>
\u00a0 \u00a0 – Insuffisance cardiaque \u00e0 FEVG pr\u00e9serv\u00e9e<\/span><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Le bilan pourra \u00eatre compl\u00e9t\u00e9 en milieu sp\u00e9cialis\u00e9<\/strong> par\u00a0:<\/span><\/h6>
Une scintigraphie osseuse aux biphosphonates<\/u>, une IRM cardiaque<\/u>, et \u00e9ventuellement la r\u00e9alisation d\u2019une biopsie<\/u> permettant de confirmer histologiquement l\u2019Amylose.<\/span><\/h6>
Il faut ensuite faire une analyse g\u00e9n\u00e9tique<\/u> pour diff\u00e9rencier les formes d\u2019amylose TTR (int\u00e9r\u00eat du d\u00e9pistage familial).<\/span><\/h6>
Le diagnostic de l\u2019amylose cardiaque repose donc sur des examens non invasifs et le recours \u00e0 un centre expert dans\u00a0 l\u2019amylose cardiaque.<\/span><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Prise en charge<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Elle se fait en collaboration avec les services de r\u00e9f\u00e9rence des maladies rares sp\u00e9cialis\u00e9s dans l\u2019amylose.<\/span><\/h6>
Arr\u00eat des BB, adaptation des doses des inhibiteurs du SRAA et, en fonction du type, du stade de la maladie et du pronostic, proposition d\u2019 un traitement sp\u00e9cifique\u00a0:<\/span><\/h6>
\u00a0 \u00a0 – Amylose TTR :<\/u> le TAFAMIDIS est actuellement utilis\u00e9 pour stabiliser la transthyr\u00e9tine pathologique et ainsi emp\u00eacher son d\u00e9p\u00f4t (traitement bien tol\u00e9r\u00e9, en prise orale)<\/span><\/h6>
Ce traitement ne permet pas d\u2019\u00e9liminer les d\u00e9p\u00f4ts d\u00e9j\u00e0 constitu\u00e9s d\u2019o\u00f9 l\u2019int\u00e9r\u00eat de poser un diagnostic pr\u00e9cocement.<\/span><\/h6>
\u00a0 \u00a0 – Amylose AL :<\/u> un programme de Chimioth\u00e9rapie adapt\u00e9<\/span><\/h6>
\u00a0<\/h6>
U<\/strong>ne \u00e9valuation g\u00e9riatrique avec d\u00e9pistage de la fragilit\u00e9 permet d\u2019argumenter la prise en charge et d\u2019apporter une aide dans la d\u00e9cision th\u00e9rapeutique<\/strong> (pour le Tafamidis: l’am\u00e9lioration clinique n\u2019est observ\u00e9e qu’au del\u00e0 de 18 mois de traitement).<\/span><\/h6>
\u00a0<\/h6>
Le triple r\u00f4le du g\u00e9riatre dans la prise en charge de l\u2019amylose cardiaque du sujet \u00e2g\u00e9\u00a0:<\/strong><\/span><\/h5>
1\u00a0:\u00a0\u00a0 D\u00e9pister et Diagnostiquer<\/u><\/strong><\/span><\/h5>
2\u00a0: \u00a0\u00a0Orienter<\/u> vers le centre de r\u00e9f\u00e9rence<\/strong><\/span><\/h5>
3\u00a0: \u00a0\u00a0\u00c9valuer la fragilit\u00e9<\/u> des patients pour \u00a0\u00a0\u00a0optimiser leur prise en charge<\/strong><\/span><\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tT\u00e9l\u00e9chargez le triptyque - D\u00e9pister l'amylose cardiaque chez le patient \u00e2g\u00e9<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

D\u00e9pister, diagnostiquer et prendre en charge les amylose cardiaques Insuffisance cardiaque et amylose\u00a0 L\u2019insuffisance cardiaque (IC) est le premier motif d\u2019hospitalisation en Unit\u00e9 de G\u00e9riatrie Aigu\u00eb. Les G\u00e9riatres sont donc en premi\u00e8re ligne avec les cardiologues dans la prise en charge de l\u2019insuffisance cardiaque du sujet \u00e2g\u00e9. l\u2019IC \u00e0 Fraction d\u2019\u00e9jection pr\u00e9serv\u00e9e est la forme […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[],"tags":[],"class_list":["post-2827","page","type-page","status-publish","hentry"],"yoast_head":"\nPour le G\u00e9riatre - R\u00e9seau Amylose<\/title>\n<meta name=\"description\" content=\"Geriatre : D\u00e9pister, diagnostiquer et prendre en charge les amylose cardiaques - visionnez les vid\u00e9os, t\u00e9l\u00e9chargez les documents\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-geriatre\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pour le G\u00e9riatre - 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