Cardiac amyloidosis medical therapy


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Overview

 * Diuretics and angiotensin-converting inhibitors are the standard therapy regimen to treat congestive heart failure secondary to cardiac amyloidosis. However, presence of hypotension may limit the use of diuretics


 * Digoxin and calcium channel blockers bind to the amyloid fibrils and thereby have been reported to increase the incidence of congestive heart failure and produce arrhythmias. Hence, these drugs may be avoided in patients with both AL and TTR cardiac amyloidosis.


 * In patients with symptomatic bradycardia, pacemakers may be indicated.

Supportive measures
Physical activity may continue as long as the patient can tolerate it.

Diet restrictions vary with the extent of cardiomyopathy and heart failure. These may include salt and/or fluid restrictions.

Pharmacotherapy
Diuretics (water pills) may be given to remove excess fluid.

Digoxin may be used cautiously to improve heart control in patients with atrial fibrillation.

Daily weight measurement may be recommended. A weight gain of 3 or 4 pounds or more over 1 or 2 days can indicate excessive fluid accumulation.

Some people benefit from chemotherapy or prednisone.

Pacemaker
A pacemaker may be needed if the conduction system is involved.