Amyloid Cardiomyopathy in Older Adults

Wild type transthyretin cardiac amyloidosis (ATTRwt, formerly called senile cardiac amyloidosis) is almost exclusively a disorder of adults over 60 years old and represents a quintessential type of diastolic heart failure in the older adult population. Cardiac amyloidosis is an infiltrative/restrictive cardiomyopathy that causes heart failure, atrial and ventricular arrhythmias, and conduction disease, and is associated with significant morbidity and mortality. Early suspicion by geriatricians including clinical clues or suggestive features when coupled with non-invasive cardiac testing that delineates a discordance between the wall thickness on echocardiography and the voltage on an electrocardiogram along with other suggestive findings on imaging of cardiac amyloidosis is paramount because early treatment can significantly improve prognosis.

With the advent of a non-invasive method to diagnose ATTRwt without a biopsy and the development of effective therapies, there is an increasing interest in this condition.

The goal of this review is to provide clinical and testing guides and pearls, for early suspicion and detection, and subsequent referral to specialist cardiologists and amyloid specialists for further management and treatment.