Cardiac Amyloidosis

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Cardiac amyloidosis occurs when amyloid proteins build up in your heart, causing it to become thick and stiff. Cardiac amyloidosis requires expert care because it can lead to life-threatening heart disease. Early diagnosis and intervention can add years to your life and help preserve your quality of life. Duke heart experts and other specialists use the latest diagnostic tools and work together to deliver the most effective, tailored treatments.

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About Cardiac Amyloidosis

When amyloid proteins build up in your heart, they can cause serious heart problems like cardiomyopathy, arrhythmia, valvular disease, heart failure, and death. 

There are two types of amyloidosis that most often cause heart problems. 

Transthyretin Amyloidosis (ATTR)
ATTR occurs when transthyretin proteins made by the liver are altered due to aging (these are called “wild-type”) or genetic mutation (these are considered “hereditary”). ATTR can attack other body systems besides the heart and is associated with conditions like carpal tunnel syndrome, spinal stenosis, neuropathy, leg swelling, fainting, digestion problems, sexual dysfunction, and more. 

Light Chain Amyloidosis (AL) 
AL occurs when plasma cells in the bone marrow produce abnormal proteins. AL is usually managed by blood, bone marrow, and heart experts.

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Duke Health offers locations throughout the Triangle. Find one near you.

Diagnosing Cardiac Amyloidosis

Your doctors may order the following tests.

Cardiac Imaging

  • An echo (echocardiogram) determines whether your heart is thicker than normal.
  • A cardiac MRI captures detailed pictures of your heart’s anatomy as well as scar tissue in the heart muscle.
  • An EKG (electrocardiogram) identifies arrhythmias and other problems with your heart’s electrical system.

Lab Tests
Blood and urine tests detect monoclonal proteins to help identify specific types of amyloidosis.

Technetium Phyrophosphate Scintigraphy (PYP) Scan
In nuclear medicine test, a liquid with radioactive tracer is injected into a vein in your arm. The tracer is attracted to areas in your heart where transthyretin proteins reside. A scanner collects 3D images of your heart and highlights the radioactive tracer.

Heart Tissue Biopsy
A thin tube (called a catheter) is inserted into a vein in your neck and guided to your heart. A small sample of tissue is removed through the catheter and examined in a lab under a microscope.

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Treating ATTR Cardiac Amyloidosis

While there are no treatments to reverse or cure ATTR cardiac amyloidosis, existing treatments can slow the disease’s progression. 

Gene-silencing oral medications stabilize transthyretin proteins before they mutate, reducing the production of amyloid. Targeted therapies shut down amyloid production or limit amyloid deposits in organs.

Device Therapies
Pacemakers and implantable cardioverter defibrillators (ICDs) help improve heart function and alleviate symptoms like shortness of breath and heart rhythm disturbances.

Heart Transplant
Heart transplantation may be an option for people who develop end-stage heart failure.

Amyloidosis Clinical Trials at Duke

Researchers believe cardiac amyloidosis is more prevalent than previously thought. Duke doctors are working to learn more about this disease, identify it sooner, and limit its effects. As a Duke patient, you may be eligible to participate in clinical trials investigating new ways to treat cardiac amyloidosis.

Why Choose Duke

Advanced Diagnostics
Duke offers every test needed to definitively diagnose your cardiac amyloidosis and its type. This saves you precious time and ensures you get the right treatment as soon as possible. 

Genetic Testing and Counseling
Because ATTR can be caused by a genetic mutation, it’s important to consider how this diagnosis could affect your family. Our genetic experts can test your children, grandchildren, and others to learn more about their risk of developing cardiac amyloidosis.

Shaping the Future of Amyloidosis Care
Many of Duke’s cardiac amyloidosis specialists are studying new ways to diagnose and treat the disease. They’re also developing ways to help identify cardiac amyloidosis sooner. Together, these efforts translate into the most advanced care for your condition.

A Team of Specialists
Amyloidosis can affect more than one organ or body system at a time, so it’s ideal to have a team of integrated specialists working together to deliver comprehensive, complementary treatment. Our team of experts in cardiology, hematology, neurology, nephrology, pathology, radiology, and genetics meets regularly to discuss patient care and research updates. We also try to combine visits with relevant providers whenever possible.

Heart Transplant Program
Our team uses advanced techniques to match more hearts with more people who need them. We perform more heart transplants than most other centers in the country, and we have some of the shortest wait times in the region.

Best Heart Hospital in North Carolina

When it comes to your heart care, you want the very best. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our cardiology and heart surgery program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2023–2024.