{"id":881,"date":"2020-09-01T15:30:55","date_gmt":"2020-09-01T13:30:55","guid":{"rendered":"http:\/\/www.reseau-amylose.org\/soignant?page_id=881"},"modified":"2020-09-01T15:30:55","modified_gmt":"2020-09-01T13:30:55","slug":"les-questions-frequentes","status":"publish","type":"page","link":"https:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-cardiologue\/les-questions-frequentes\/","title":{"rendered":"Les questions fr\u00e9quentes"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"881\" class=\"elementor elementor-881\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-12e011b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"12e011b\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6176a4b\" data-id=\"6176a4b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-62a811e elementor-widget elementor-widget-text-editor\" data-id=\"62a811e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"color: #000000;\">Cher confr\u00e8re,\u00a0<\/span><\/p><p><span style=\"color: #000000;\">Vous trouverez dans cette rubrique, les r\u00e9ponses aux question les plus fr\u00e9quentes.<\/span><\/p><p><span style=\"color: #000000;\">N&rsquo;h\u00e9sitez pas \u00e0 nous transmettre vos cas cliniques et interrogations en cliquant sur le lien suivant :<\/span> <a href=\"https:\/\/www.reseau-amylose.org\/envoyer-un-message\/\" target=\"_blank\" rel=\"noopener\">ENVOYER UN MESSAGE<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2848636 elementor-widget elementor-widget-text-editor\" data-id=\"2848636\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h5><span style=\"color: #4db8f0;\">Quand suspecter une amylose cardiaque chez votre patient ?\u00a0<\/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<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5711395 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5711395\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-fba1bf3\" data-id=\"fba1bf3\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8a18f84 elementor-widget elementor-widget-video\" data-id=\"8a18f84\" data-element_type=\"widget\" data-settings=\"{&quot;youtube_url&quot;:&quot;https:\\\/\\\/www.youtube.com\\\/watch?v=vizkC53FVnw&quot;,&quot;video_type&quot;:&quot;youtube&quot;,&quot;controls&quot;:&quot;yes&quot;}\" data-widget_type=\"video.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-wrapper elementor-open-inline\">\n\t\t\t<div class=\"elementor-video\"><\/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<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-3640828\" data-id=\"3640828\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2285593 elementor-widget elementor-widget-text-editor\" data-id=\"2285593\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"font-style: inherit !important; font-weight: inherit !important; color: #000000;\">Les amyloses cardiaques sont plus fr\u00e9quentes qu\u2019attendues notamment chez le patient de plus de 55 ans. Il faut rechercher une amylose cardiaque chez un patient pr\u00e9sentant des signes d\u2019insuffisance cardiaque avec une augmentation de l\u2019\u00e9paisseur des parois ventriculaires. <\/span><\/p><p><span style=\"color: #000000;\">Les diagnostics diff\u00e9rentiels les plus fr\u00e9quents sont\u00a0: la cardiopathie hypertensive, l\u2019insuffisance cardiaque \u00e0 FEVG pr\u00e9serv\u00e9e, \u00a0la cardiomyopathie hypertrophique ou la cardiopathie restrictive.<\/span><\/p><p><span style=\"font-style: inherit !important; font-weight: inherit !important; color: #000000;\">Les amyloses sont fr\u00e9quentes chez les sujets \u00e2g\u00e9s qui ont fr\u00e9quemment une histoire d\u2019hypertension art\u00e9rielle. L\u2019HTA peut \u00eatre un facteur de confusion. Toutefois, dans un contexte d\u2019amylose du fait du bas d\u00e9bit associ\u00e9, la pression art\u00e9rielle diminue, il est fr\u00e9quent qu\u2019un ou plusieurs traitements antihypertenseurs aient \u00e9t\u00e9 arr\u00eat\u00e9s. <\/span><\/p><p><span style=\"color: #000000;\">Le diagnostic d\u2019amylose va bien-s\u00fbr changer la prise en charge cardiologique et la prise en charge sp\u00e9cifique.<\/span><\/p>\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<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d956a91 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d956a91\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0f9abc2\" data-id=\"0f9abc2\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d24942f elementor-widget elementor-widget-text-editor\" data-id=\"d24942f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h5><span style=\"color: #4db8f0;\">Que prescrire pour le diagnostic de l&rsquo;amylose : scintigraphie, recherche de gammapathies ou biopsie ?<\/span><\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8dd5272 elementor-widget elementor-widget-video\" data-id=\"8dd5272\" data-element_type=\"widget\" data-settings=\"{&quot;youtube_url&quot;:&quot;https:\\\/\\\/www.youtube.com\\\/watch?v=XHOmBV4js_Ehttps:\\\/\\\/youtu.be\\\/XkKLoUaycvs&quot;,&quot;video_type&quot;:&quot;youtube&quot;,&quot;controls&quot;:&quot;yes&quot;}\" data-widget_type=\"video.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-wrapper elementor-open-inline\">\n\t\t\t<div class=\"elementor-video\"><\/div>\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1da484f elementor-widget elementor-widget-text-editor\" data-id=\"1da484f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"color: #000000;\">La scintigraphie osseuse coupl\u00e9e au SPECT est l\u2019examen cl\u00e9 pour le diagnostic des amyloses. Elle est souvent r\u00e9alis\u00e9e en premi\u00e8re intention apr\u00e8s une \u00e9chocardiographie ou apr\u00e8s une IRM cardiaque.<\/span><\/p><p><span style=\"color: #000000;\">La scintigraphie osseuse ne s\u2019interpr\u00e8te qu\u2019en fonction de la pr\u00e9sence ou non d\u2019une gammapathie. Il faut donc prescrire les examens pour rechercher une gammapathie simultan\u00e9ment \u00e0 la scintigraphie.<\/span><\/p><p><span style=\"color: #000000;\">Pour rechercher une gammapathie 4 examens \u00e0 prescrire :<\/span><\/p><p><span style=\"color: #000000;\">1-Electrophor\u00e8se s\u00e9rique,<\/span><\/p><p><span style=\"color: #000000;\">2-Immunofixation s\u00e9rique,<\/span><\/p><p><span style=\"color: #000000;\">3-Dosage des Chaines l\u00e9g\u00e8res Libres et<\/span><\/p><p><span style=\"color: #000000;\">4- Recherche de prot\u00e9inurie de Bence Jones dans les urines.<\/span><\/p><p><span style=\"color: #000000;\">L\u2019analyse des r\u00e9sultats de la scintigraphie et de la recherche de gammapathie:<\/span><\/p><p><span style=\"color: #000000;\">1\/ En pr\u00e9sence d\u2019une FIXATION CARDIAQUE SANS gammapathie : Le diagnostic est en faveur d\u2019une amylose cardiaque \u00e0 transthyr\u00e9tine (TTR). Faire une analyse g\u00e9n\u00e9tique du g\u00e8ne TTR pour diff\u00e9rencier l\u2019amylose TTR dite s\u00e9nile de l\u2019amylose TTR h\u00e9r\u00e9ditaire (Pr\u00e9sence d\u2019une mutation dans le g\u00e8ne TTR).<\/span><\/p><p><span style=\"color: #000000;\">2\/ En pr\u00e9sence d\u2019une FIXATION CARDIAQUE AVEC gammapathie : Il peut s\u2019agir d\u2019une Amylose \u00e0 transthyr\u00e9tine associ\u00e9e \u00e0 une MGUS ou une Amylose AL avec une fixation cardiaque (10% des cas environ). Il faut compl\u00e9ter le bilan par une preuve histologique (Adresser le patient \u00e0 un centre sp\u00e9cialis\u00e9?).<\/span><\/p><p><span style=\"color: #000000;\">3\/ En l\u2019absence de fixation cardiaque mais AVEC une gammapathie : Attention, il s\u2019agit probablement d\u2019une Amylose AL. C\u2019est une urgence diagnostic. (Adresser le patient \u00e0 un centre sp\u00e9cialis\u00e9?). Une scintigraphie cardiaque au traceur osseux normale (sans fixation cardiaque) n\u2019\u00e9limine donc pas le diagnostic d\u2019amylose.<\/span><\/p><p><span style=\"color: #000000;\">4\/ En l\u2019absence de fixation cardiaque ET en l\u2019absence de gammapathie : Revoir le diagnostic d\u2019amylose. IL ne s\u2019agit probablement pas d\u2019une amylose ou alors d\u2019une forme amylose cardiaque rare (amylose TTR h\u00e9r\u00e9ditaire \u00e0 forme neurologique, Amylose AL sans cha\u00eene l\u00e9g\u00e8re libre dans le s\u00e9rum). Si vous \u00eates sur du diagnostic de l\u2019amylose, il serait bien d\u2019adresser le patient \u00e0 un centre sp\u00e9cialis\u00e9 pour avis.<\/span><\/p>\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<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2769f4a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2769f4a\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-0ee293c\" data-id=\"0ee293c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ea796b4 elementor-widget elementor-widget-text-editor\" data-id=\"ea796b4\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h6 style=\"text-align: center;\"><strong><span style=\"color: #000000;\">T\u00e9l\u00e9chargez l&rsquo;ordonnance type pour la r\u00e9alisation d&rsquo;une <\/span><\/strong><\/h6><h6 style=\"text-align: center;\"><strong><span style=\"color: #000000;\">scintigraphie osseuse<\/span><\/strong><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2a6c47b elementor-align-center elementor-widget elementor-widget-button\" data-id=\"2a6c47b\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-md\" href=\"https:\/\/www.reseau-amylose.org\/jesuissoignant\/storage\/sites\/13\/2020\/10\/Amylose_Ordonnance-pour-Scintigraphie-cardiaque-au-Traceur-Osseux-4.pdf\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Cliquez ici<\/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<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-fc6c65a\" data-id=\"fc6c65a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-690b65c elementor-widget elementor-widget-text-editor\" data-id=\"690b65c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h6 style=\"text-align: center;\"><span style=\"color: #000000;\">T\u00e9l\u00e9chargez l&rsquo;ordonnance type pour une recherche de <\/span><\/h6><h6 style=\"text-align: center;\"><span style=\"color: #000000;\">gammapathies<\/span><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-63be1b6 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"63be1b6\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-md\" href=\"https:\/\/www.reseau-amylose.org\/jesuissoignant\/storage\/sites\/13\/2020\/10\/Amylose_Ordonnance-pour-rechercher-une-gammapathie-4.pdf\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Cliquez ici<\/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\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-31816d3 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"31816d3\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e9d620a\" data-id=\"e9d620a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4b1d275 elementor-widget elementor-widget-text-editor\" data-id=\"4b1d275\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h5><span style=\"color: #4db8f0;\">Pourquoi prescrire un test g\u00e9n\u00e9tique pour le diagnostic d&rsquo;une amylose cardiaque ?<\/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<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9b493c1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9b493c1\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-849797d\" data-id=\"849797d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-397c4f6 elementor-widget elementor-widget-video\" data-id=\"397c4f6\" data-element_type=\"widget\" data-settings=\"{&quot;youtube_url&quot;:&quot;https:\\\/\\\/youtu.be\\\/TlGtVwmxS8g&quot;,&quot;video_type&quot;:&quot;youtube&quot;,&quot;controls&quot;:&quot;yes&quot;}\" data-widget_type=\"video.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-wrapper elementor-open-inline\">\n\t\t\t<div class=\"elementor-video\"><\/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<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-12739da\" data-id=\"12739da\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3fe4673 elementor-widget elementor-widget-text-editor\" data-id=\"3fe4673\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"color: #000000;\">Il est n\u00e9cessaire de prescrire un test g\u00e9n\u00e9tique TTR chez tous patients atteints d\u2019amylose \u00e0 transthyr\u00e9tine quelque soit l\u2019\u00e2ge. Seule la r\u00e9alisation de ce test permet de diff\u00e9rencier la forme h\u00e9r\u00e9ditaire et la forme s\u00e9nile. Les amyloses h\u00e9r\u00e9ditaires \u00e0 transthyr\u00e9tine peuvent devenir symptomatique \u00e0 un \u00e2ge \u00e9lev\u00e9 c.\u00e0.d. au-del\u00e0 de 80 ans. On ne peut donc conclure au diagnostic d\u2019amylose \u00e0 transthyr\u00e9tine uniquement du fait de l\u2019\u00e2ge. \u00a0\u00a0<\/span><\/p><p><span style=\"color: #000000;\">Le g\u00e8ne TTR est un g\u00e8ne de court de 4 exons. Plus de 120 mutations ont \u00e9t\u00e9 d\u00e9crites. A chaque mutation correspond un profil ph\u00e9notypique et une histoire de maladie. La transmission de la maladie est autosomique dominante. L\u2019identification d\u2019une mutation permettra de prendre en charge la famille du patient dans le cadre du conseil g\u00e9n\u00e9tique.<\/span><\/p><p><span style=\"color: #000000;\">L\u2019identification des membres de la famille porteur de la mutation permettra une prise en charge plus pr\u00e9coce et la mise en place d\u2019un projet th\u00e9rapeutique.<\/span><\/p>\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<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3b2ef94 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3b2ef94\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-27b1e77\" data-id=\"27b1e77\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1c18d60 elementor-widget elementor-widget-text-editor\" data-id=\"1c18d60\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h5><span style=\"color: #4db8f0;\">Pourquoi ne pas prescrire de b\u00e9tabloquants dans l&rsquo;amylose cardiaque ?<\/span><\/h5><p><span style=\"color: #000000;\">Les b\u00e9tabloquants sont d\u00e9l\u00e9t\u00e8res dans les amyloses cardiaques. Dans l\u2019amylose, l\u2019infiltration rigidifie le myocarde et diminue la cavit\u00e9 ventriculaire du fait de l\u2019augmentation de l\u2019\u00e9paisseur myocardique. Les volumes systoliques et diastoliques des cavit\u00e9s ventriculaires sont donc r\u00e9duits et particuli\u00e8rement le volume de sang \u00e9ject\u00e9 \u00e0 chaque contraction cardiaque. Le d\u00e9bit cardiaque \u00e9tant le produit de la fr\u00e9quence cardiaque et du volume d\u2019\u00e9jection systolique, on comprend bien que le d\u00e9bit va particuli\u00e8rement d\u00e9pendre de la fr\u00e9quence cardiaque dans les amyloses cardiaques. Baisser la fr\u00e9quence cardiaque va imm\u00e9diatement diminuer le d\u00e9bit cardiaque. Les b\u00e9tabloquants ont \u00e9galement un effet inotrope n\u00e9gatif et dromotrope n\u00e9gatif qui peuvent alt\u00e9rer la contractilit\u00e9 et la conduction cardiaque.<\/span><\/p><p><span style=\"color: #000000;\">Tous les m\u00e9dicaments diminuant la fr\u00e9quence cardiaque sont donc \u00e0 \u00e9viter dans les amyloses cardiaques (b\u00e9tabloquant, v\u00e9rapamil, procoralan\u2026etc\u2026)<\/span><\/p><p><span style=\"color: #000000;\">Il existe pour autant de rare indication de b\u00e9tabloquant comme la fibrillation atriale tr\u00e8s rapide (&gt;120\/min) ou mal tol\u00e9r\u00e9e ou une obstruction symptomatique.<\/span><\/p>\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<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e28257b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e28257b\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-83222a7\" data-id=\"83222a7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0a27105 elementor-widget elementor-widget-text-editor\" data-id=\"0a27105\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h5><span style=\"color: #4db8f0;\">Gammapathie et amylose \u00e0 transthyr\u00e9tine &#8211; jusqu&rsquo;o\u00f9 pousser le bilan ?\u00a0<\/span><\/h5><p><em><span style=\"color: #4db8f0;\">Olivier LAIREZ<\/span><\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a3d6b98 elementor-widget elementor-widget-video\" data-id=\"a3d6b98\" data-element_type=\"widget\" data-settings=\"{&quot;youtube_url&quot;:&quot;https:\\\/\\\/www.youtube.com\\\/watch?v=A3AOmuD0r0c&amp;ab_channel=R%C3%A9seauAmylose&quot;,&quot;video_type&quot;:&quot;youtube&quot;,&quot;controls&quot;:&quot;yes&quot;}\" data-widget_type=\"video.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-wrapper elementor-open-inline\">\n\t\t\t<div class=\"elementor-video\"><\/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<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Cher confr\u00e8re,\u00a0 Vous trouverez dans cette rubrique, les r\u00e9ponses aux question les plus fr\u00e9quentes. N&rsquo;h\u00e9sitez pas \u00e0 nous transmettre vos cas cliniques et interrogations en cliquant sur le lien suivant : ENVOYER UN MESSAGE Quand suspecter une amylose cardiaque chez votre patient ?\u00a0 https:\/\/www.youtube.com\/watch?v=vizkC53FVnw Les amyloses cardiaques sont plus fr\u00e9quentes qu\u2019attendues notamment chez le patient [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":115,"menu_order":6,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"class_list":["post-881","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Les questions fr\u00e9quentes - R\u00e9seau Amylose<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-cardiologue\/les-questions-frequentes\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Les questions fr\u00e9quentes - R\u00e9seau Amylose\" \/>\n<meta property=\"og:description\" content=\"Cher confr\u00e8re,\u00a0 Vous trouverez dans cette rubrique, les r\u00e9ponses aux question les plus fr\u00e9quentes. N&rsquo;h\u00e9sitez pas \u00e0 nous transmettre vos cas cliniques et interrogations en cliquant sur le lien suivant : ENVOYER UN MESSAGE Quand suspecter une amylose cardiaque chez votre patient ?\u00a0 https:\/\/www.youtube.com\/watch?v=vizkC53FVnw Les amyloses cardiaques sont plus fr\u00e9quentes qu\u2019attendues notamment chez le patient [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"http:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-cardiologue\/les-questions-frequentes\/\" \/>\n<meta property=\"og:site_name\" content=\"R\u00e9seau Amylose\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-cardiologue\/les-questions-frequentes\/\",\"url\":\"http:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-cardiologue\/les-questions-frequentes\/\",\"name\":\"Les questions fr\u00e9quentes - R\u00e9seau Amylose\",\"isPartOf\":{\"@id\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/#website\"},\"datePublished\":\"2020-09-01T13:30:55+00:00\",\"breadcrumb\":{\"@id\":\"http:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-cardiologue\/les-questions-frequentes\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-cardiologue\/les-questions-frequentes\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-cardiologue\/les-questions-frequentes\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Accueil\",\"item\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Pour le cardiologue\",\"item\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-cardiologue\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Les questions fr\u00e9quentes\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/#website\",\"url\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/\",\"name\":\"R\u00e9seau Amylose\",\"description\":\"Centre de r\u00e9f\u00e9rence des amyloses cardiaques espace soignant\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"fr-FR\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Les questions fr\u00e9quentes - R\u00e9seau Amylose","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"http:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-cardiologue\/les-questions-frequentes\/","og_locale":"fr_FR","og_type":"article","og_title":"Les questions fr\u00e9quentes - R\u00e9seau Amylose","og_description":"Cher confr\u00e8re,\u00a0 Vous trouverez dans cette rubrique, les r\u00e9ponses aux question les plus fr\u00e9quentes. 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