Utility and pitfalls of the electrocardiogram in the evaluation of cardiac amyloidosis
Abstract Background Cardiac amyloidosis is a protein misfolding disorder involving deposition of amyloid fibril proteins in the heart. The associated fibrosis of the conduction tissue results in conduction abnormalities and arrhythmias. “Classical” electrocardiogram (ECG) findings in cardiac amyloid...
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Format: | Article |
Language: | English |
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Wiley
2022-07-01
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Series: | Annals of Noninvasive Electrocardiology |
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Online Access: | https://doi.org/10.1111/anec.12967 |
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author | Perryn Lin Fei Ng Yoke Ching Lim Lauren Kay Mance Evangelista Raymond Ching Chiew Wong Ping Chai Ching Hui Sia Hoi Yin Loi Tiong Cheng Yeo Weiqin Lin |
author_facet | Perryn Lin Fei Ng Yoke Ching Lim Lauren Kay Mance Evangelista Raymond Ching Chiew Wong Ping Chai Ching Hui Sia Hoi Yin Loi Tiong Cheng Yeo Weiqin Lin |
author_sort | Perryn Lin Fei Ng |
collection | DOAJ |
description | Abstract Background Cardiac amyloidosis is a protein misfolding disorder involving deposition of amyloid fibril proteins in the heart. The associated fibrosis of the conduction tissue results in conduction abnormalities and arrhythmias. “Classical” electrocardiogram (ECG) findings in cardiac amyloidosis include that of low voltage complexes with increased left ventricular wall thickness on echocardiography. However, this “classical” finding is neither sensitive nor specific. As cardiac amyloidosis is associated with a generally poor prognosis, the need for early recognition of this disease is important given the availability of new treatment options. In this review, we highlight 3 cases of patients with cardiac amyloidosis. Although presenting with typical clinical signs and symptoms, ECG for all 3 patients was not consistent with the classical findings described. They underwent further diagnostic tests which clinched the diagnosis of cardiac amyloidosis, allowing patients to receive targeted treatment. Through the review of the literature, we will highlight the different ECG patterns in patients with different types of cardiac amyloidosis and clinical scenarios, as well as the pitfalls of using ECG to identify the condition. Lastly, we also emphasize the current paradigms in diagnosing cardiac amyloidosis through the non‐invasive methods of echocardiography, cardiac magnetic resonance imaging, and nuclear technetium‐pyrophosphate imaging. Conclusions Electrocardiogram is often the first investigation used in evaluating many cardiac disorders, including cardiac amyloidosis. However, classical features of cardiac amyloidosis on ECG are often not present. A keen understanding on the ECG features of cardiac amyloidosis and knowledge of the diagnostic workflow is important to diagnose this condition. |
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format | Article |
id | doaj.art-8a158cea4f114354b59195cf338ed068 |
institution | Directory Open Access Journal |
issn | 1082-720X 1542-474X |
language | English |
last_indexed | 2024-04-13T05:50:25Z |
publishDate | 2022-07-01 |
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series | Annals of Noninvasive Electrocardiology |
spelling | doaj.art-8a158cea4f114354b59195cf338ed0682022-12-22T02:59:49ZengWileyAnnals of Noninvasive Electrocardiology1082-720X1542-474X2022-07-01274n/an/a10.1111/anec.12967Utility and pitfalls of the electrocardiogram in the evaluation of cardiac amyloidosisPerryn Lin Fei Ng0Yoke Ching Lim1Lauren Kay Mance Evangelista2Raymond Ching Chiew Wong3Ping Chai4Ching Hui Sia5Hoi Yin Loi6Tiong Cheng Yeo7Weiqin Lin8Department of Cardiology National University Heart Centre Singapore SingaporeDepartment of Cardiology National University Heart Centre Singapore SingaporeDepartment of Cardiology National University Heart Centre Singapore SingaporeDepartment of Cardiology National University Heart Centre Singapore SingaporeDepartment of Cardiology National University Heart Centre Singapore SingaporeDepartment of Cardiology National University Heart Centre Singapore SingaporeYong Loo Lin School of Medicine National University of Singapore Singapore SingaporeDepartment of Cardiology National University Heart Centre Singapore SingaporeDepartment of Cardiology National University Heart Centre Singapore SingaporeAbstract Background Cardiac amyloidosis is a protein misfolding disorder involving deposition of amyloid fibril proteins in the heart. The associated fibrosis of the conduction tissue results in conduction abnormalities and arrhythmias. “Classical” electrocardiogram (ECG) findings in cardiac amyloidosis include that of low voltage complexes with increased left ventricular wall thickness on echocardiography. However, this “classical” finding is neither sensitive nor specific. As cardiac amyloidosis is associated with a generally poor prognosis, the need for early recognition of this disease is important given the availability of new treatment options. In this review, we highlight 3 cases of patients with cardiac amyloidosis. Although presenting with typical clinical signs and symptoms, ECG for all 3 patients was not consistent with the classical findings described. They underwent further diagnostic tests which clinched the diagnosis of cardiac amyloidosis, allowing patients to receive targeted treatment. Through the review of the literature, we will highlight the different ECG patterns in patients with different types of cardiac amyloidosis and clinical scenarios, as well as the pitfalls of using ECG to identify the condition. Lastly, we also emphasize the current paradigms in diagnosing cardiac amyloidosis through the non‐invasive methods of echocardiography, cardiac magnetic resonance imaging, and nuclear technetium‐pyrophosphate imaging. Conclusions Electrocardiogram is often the first investigation used in evaluating many cardiac disorders, including cardiac amyloidosis. However, classical features of cardiac amyloidosis on ECG are often not present. A keen understanding on the ECG features of cardiac amyloidosis and knowledge of the diagnostic workflow is important to diagnose this condition.https://doi.org/10.1111/anec.12967cardiac amyloidosiselectrocardiogramlight chain amyloidosistransthyretin amyloidosis |
spellingShingle | Perryn Lin Fei Ng Yoke Ching Lim Lauren Kay Mance Evangelista Raymond Ching Chiew Wong Ping Chai Ching Hui Sia Hoi Yin Loi Tiong Cheng Yeo Weiqin Lin Utility and pitfalls of the electrocardiogram in the evaluation of cardiac amyloidosis Annals of Noninvasive Electrocardiology cardiac amyloidosis electrocardiogram light chain amyloidosis transthyretin amyloidosis |
title | Utility and pitfalls of the electrocardiogram in the evaluation of cardiac amyloidosis |
title_full | Utility and pitfalls of the electrocardiogram in the evaluation of cardiac amyloidosis |
title_fullStr | Utility and pitfalls of the electrocardiogram in the evaluation of cardiac amyloidosis |
title_full_unstemmed | Utility and pitfalls of the electrocardiogram in the evaluation of cardiac amyloidosis |
title_short | Utility and pitfalls of the electrocardiogram in the evaluation of cardiac amyloidosis |
title_sort | utility and pitfalls of the electrocardiogram in the evaluation of cardiac amyloidosis |
topic | cardiac amyloidosis electrocardiogram light chain amyloidosis transthyretin amyloidosis |
url | https://doi.org/10.1111/anec.12967 |
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