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Case 15
History
- 45 year old Female
- Fatigue x 6/12, Dyspnea x 2/52
Findings
Diagnosis
Cardiac amyloid: Pericardial effusion with tamponade physiology and myocardial infiltration
- Amyloidosis: (AA) most common type worldwide- chronic inflammatory disease; usually chronic infection or rheumatic disease
- (AL) Light chain type the most common in the US
- Pericardial effusion: Tamponade is the hemodynamic result of fluid accumulation. Needs urgent drainage.
- Tamponade Physiology: Collapse of the right atrial free wall: sensitive. Collapse of the right ventricular free wall more specific
Cardiac amyloid
- Restrictive Cardiomyopathy:
- Myocardial infiltraton: Typically diffuse. Therefore difficulty on the TI scout. Difficult to find the correct * TI time to null the myocardium.
- Also: T1 shortening has been reported. Important diagnosis:
Treatment
- Cardiac Tamponade: Urgent drainage.
- Diuretics.
- B-blockers and Ace inhibitors risk hypotension.
- Digoxin and CA blockers bind to amyloid fibrils
- Also treat underlying cause e.g chemotherapy for myeloma. Cardiac transplantation
- Newer agents such aseprodisate ; a glycosaminoglycan