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Theory and Practice in Medicine, 2015 Vol. 21 No. 4.3


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CARDIAC AMYLOIDOSIS

Mykolas Biliukas, Vaiva Karpavičienė


Correspondence Address: mbiliukas@gmail.com

Key words: amyloid, cardiac amyloidosis, cardiomyopathy, diagnostics, treatment.
Amyloidosis is a rare, severe, heavily diagnosed and treated systemic disease. Stranger protein may accumulate in any organ, but cardiac involvement more often occurs in acquired monoclonal light-chain, hereditary transthyretin, senile amyloidosis and has a major impact on a poor prognosis. That is why early assessment of cardiac amyloidosis is essential factor for successful
treatment. According to a particular clinic case, we aimed to inspect diagnostic packet in the department, presenting secondary level of cardiologic facilities, introduce with base clinical forms, gave staging system for assessing cardiac involvement severity, based on troponin I and proBNP. Considerable attention was paid to propaedeutic extra-cardiac symptoms and features in the start of disease. Data of bone marrow, hypodermal biopsy and histochemical research are presented. Left ventricular hypertrophy on transthoracic echocardiography contrasting with micro-voltage of QRS amplitude is appropriate for heart amyloidosis. Trying to assess cardiovascular state more accurately, modern technology such as tissue dopplerometry and cardiac magnetic resonance tomography are discussed. Medical community is introduced with main treatment principles of heart amyloidosis, their distribution between internists, hematologists and other specialists. Treatment differentiates in accordance with type of amyloidosis. Topping or regression of advanced heart amyloidosis is not proved. That is why preferential attention falls in cardiac supportive treatment having some exceptional features in different groups of drugs, such as glycosides, beta-blockers, angiotensin – converting enzyme inhibitors and receptor blockers, loop diuretics. Ignorance of these peculiarities may be formidable for patients. The main role in treating secondary amyloidosis remains for treatment of causal disease.



DOI: 10.15591/mtp.2015.139
Submited: October 5, 2015.
Accepted: October 26, 2015.
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