Abstract :Heart Failure is a common condition in the aged population with a multitude of underlying causes.
Cardiac Amyloidosis (CA) is now known to play a significant role in the development of heart failure
in aged patients. However, CA remains underappreciated as a cause of heart failure and continues
to go undiagnosed. The clinical manifestations of CA are non-specific cardiac findings (e.g. heart
failure, dyspnea, atrial arrythmias) and potential multi-system dysfunction (liver, kidney, and/or
nervous system) making a high index of suspicion crucial to CA diagnosis. Some laboratory results
and electrocardiographic findings can increase suspicion of CA in aged patients. However, none of
those findings are diagnostic nor can their absence rule out the disease. Several echocardiographic
findings should increase suspicion for CA, but of these, depressed global longitudinal strain with
relative apical sparing is the most sensitive and specific to CA and warrants further investigation.
Cardiac MRI can accurately identify all types of CA, even in early-stage disease. Diffuse late
gadolinium enhancement as well as increased T1 native and extracellular volume on cardiac MRI
are highly sensitive and specific markers but cannot yet definitively type the off ending amyloid
protein. Nuclear bone scintigraphy can diagnose one type of CA, but all other suspected cases require
endomyocardial biopsy for diagnosis. Recently, several promising disease-modifying therapies have
emerged that can improve outcomes in CA patients. These treatments are most effective in earlystage
disease, further emphasizing the need for more frequent early-diagnosis.