Cardiac Amyloidosis

A patient with cardiac amyloidosis may look as though they have ordinary heart failure with preserved ejection fraction: dyspnea, edema, atrial fibrillation, and a seemingly thickened left ventricle. The mechanism is different. Misfolded protein has infiltrated the heart, so the ventricle becomes stiff rather than simply hypertrophied. It fills poorly, filling pressures rise, and stroke volume becomes relatively fixed. Ejection fraction can remain normal even while forward perfusion falls. The first question is not merely whether amyloid is present; it is which protein is responsible. AL amyloidosis arises from a plasma-cell clone that produces misfolded immunoglobulin light chains and can deteriorate rapidly. ATTR amyloidosis results from transthyretin fibrils and may be wild-type or hereditary/variant. The two forms require different specialist treatments. A new monoclonal protein in a patient with cardiac involvement therefore changes the urgency immediately: AL must be addressed as a time-critical haematologic disorder, not managed as routine heart failure. The nurse’s pattern recognition often starts before a definitive test: unexplained ventricular thickening or HFpEF, disproportionate diastolic dysfunction, atrial or conduction disease, orthostatic symptoms, and a history of bilateral...