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  • 00:00:15
    It's important to really have a high index of suspicion when you're seeing somebody
  • 00:00:20
    with worsening heart failure who has other signs of AL amyloidosis.
  • 00:00:25
    As a cardiologist, AL cardiac amyloidosis will manifest itself to you in a couple of ways.
  • 00:00:32
    Patients will come to you with worsening heart failure symptoms.
  • 00:00:36
    They are going to develop thickening of the heart wall.
  • 00:00:40
    So we look at left ventricular wall thickness in excess of 12 mm on echo
  • 00:00:46
    in the absence of other causes, like hypertension, hypertrophic cardiomyopathy.
  • 00:00:58
    It becomes very important to be able to communicate with your nephrology colleagues
  • 00:01:05
    when you see somebody with heart failure who also has a lot of protein in their urine.
  • 00:01:09
    It becomes important to collaborate with your neurology colleagues when you see
  • 00:01:15
    somebody with heart failure who also has a peripheral neuropathy or an autonomic neuropathy.
  • 00:01:20
    That’s because this disease has myriad manifestations
  • 00:01:24
    and if you ignore other organ systems,
  • 00:01:27
    you’re going to miss the fact that the patient has AL cardiac amyloidosis.
  • 00:01:31
    So that’s why because it’s a systemic disease,
  • 00:01:34
    cross-disciplinary collaborations are imperative to an early diagnosis.
  • 00:01:45
    A cardiologist will obtain an electrocardiogram,
  • 00:01:48
    an ECG, and an echocardiogram, and those two tests will start pointing towards
  • 00:01:55
    an infiltrative cardiomyopathy or a restrictive cardiomyopathy.
  • 00:01:59
    Now, the next step becomes figuring out whether this is really cardiac amyloidosis or not.
  • 00:02:05
    Sometimes, a cardiac MRI can be helpful in making that diagnosis.
  • 00:02:11
    So your job now is to figure out what the precursor protein is,
  • 00:02:15
    and that can be done by ruling out a plasma cell dyscrasia,
  • 00:02:20
    by checking serum and urine immunofluorescence electrophoresis,
  • 00:02:26
    by checking serum-free light chains.
  • 00:02:28
    The next step is to rule out transthyretin cardiac amyloidosis,
  • 00:02:33
    and that needs to be ruled out by a pyrophosphate scan.
  • 00:02:37
    When there is suspicion of cardiac amyloidosis,
  • 00:02:39
    I think it’s important to involve a hematologist early,
  • 00:02:43
    because a hematologist can really help you with doing that workup for a plasma cell dyscrasia.