AMY DA site - I can identify - Video 1

Chapters

• 00:00:15
  It's important to really have a high index of suspicion when you're seeing somebody
• 00:00:20
  with worsening heart failure who has other signs of AL amyloidosis.
• 00:00:25
  As a cardiologist, AL cardiac amyloidosis will manifest itself to you in a couple of ways.
• 00:00:32
  Patients will come to you with worsening heart failure symptoms.
• 00:00:36
  They are going to develop thickening of the heart wall.
• 00:00:40
  So we look at left ventricular wall thickness in excess of 12 mm on echo
• 00:00:46
  in the absence of other causes, like hypertension, hypertrophic cardiomyopathy.
• 00:00:58
  It becomes very important to be able to communicate with your nephrology colleagues
• 00:01:05
  when you see somebody with heart failure who also has a lot of protein in their urine.
• 00:01:09
  It becomes important to collaborate with your neurology colleagues when you see
• 00:01:15
  somebody with heart failure who also has a peripheral neuropathy or an autonomic neuropathy.
• 00:01:20
  That’s because this disease has myriad manifestations
• 00:01:24
  and if you ignore other organ systems,
• 00:01:27
  you’re going to miss the fact that the patient has AL cardiac amyloidosis.
• 00:01:31
  So that’s why because it’s a systemic disease,
• 00:01:34
  cross-disciplinary collaborations are imperative to an early diagnosis.
• 00:01:45
  A cardiologist will obtain an electrocardiogram,
• 00:01:48
  an ECG, and an echocardiogram, and those two tests will start pointing towards
• 00:01:55
  an infiltrative cardiomyopathy or a restrictive cardiomyopathy.
• 00:01:59
  Now, the next step becomes figuring out whether this is really cardiac amyloidosis or not.
• 00:02:05
  Sometimes, a cardiac MRI can be helpful in making that diagnosis.
• 00:02:11
  So your job now is to figure out what the precursor protein is,
• 00:02:15
  and that can be done by ruling out a plasma cell dyscrasia,
• 00:02:20
  by checking serum and urine immunofluorescence electrophoresis,
• 00:02:26
  by checking serum-free light chains.
• 00:02:28
  The next step is to rule out transthyretin cardiac amyloidosis,
• 00:02:33
  and that needs to be ruled out by a pyrophosphate scan.
• 00:02:37
  When there is suspicion of cardiac amyloidosis,
• 00:02:39
  I think it’s important to involve a hematologist early,
• 00:02:43
  because a hematologist can really help you with doing that workup for a plasma cell dyscrasia.