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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Main Authors: 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
Format: Article
Language:English
Published: Wiley 2022-07-01
Series:Annals of Noninvasive Electrocardiology
Subjects:
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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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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