Amyloid cardiomyopathy in the elderly: clinical options, difficulties in diagnosis and treatment

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Abstract

This article analyzes the frequency and features of cardiac amyloidosis in the elderly. The morphology and pathogenesis of amyloid cardiomyopathy are presented. The features of the clinical picture of the heart and aortic lesions in systemic and local variants of amyloidosis are analyzed. Polymorbidity in older people, which complicates the diagnosis of cardiac amyloidosis and leads to a delay in treatment, is reviewed. The diagnostic methods of various types of cardiac amyloidosis are evaluated. Modern trends in the treatment of amyloidosis are presented.

About the authors

Ol’ga A. Ettinger

N.I.Pirogov Russian National Research Medical University

Author for correspondence.
Email: exampl@mail.ru
ORCID iD: 0000-0002-1237-3731

MD, PhD

Russian Federation, 117997, Moscow

Gennadiy E. Gendlin

N.I.Pirogov Russian National Research Medical University

Email: exampl@mail.ru
ORCID iD: 0000-0002-7846-1611

MD, PhD, DSc, Professor

Russian Federation, 117997, Moscow

Elena A. Stepanova

V.M. Buyanov Moscow City Clinical Hospital; Russian Medical Academy of Continuing Professional Education

Email: exampl@mail.ru
ORCID iD: 0000-0001-7760-5858

врач-патологоанатом; ассистент кафедры патологической анатомии 

Russian Federation, 115056, Moscow; 125993, Moscow

Irina I. Ganieva

V.M. Buyanov Moscow City Clinical Hospital

Email: exampl@mail.ru
ORCID iD: 0000-0002-2429-1629

врач-кардиолог 

Russian Federation, 115056, Moscow

Svetlana V. Borisovskaya

N.I.Pirogov Russian National Research Medical University; V.M. Buyanov Moscow City Clinical Hospital

Email: exampl@mail.ru
ORCID iD: 0000-0002-9365-1472

MD, PhD

Russian Federation, 117997,Moscow; 115056, Moscow

Il’ya G. Fedorov

N.I.Pirogov Russian National Research Medical University; V.M. Buyanov Moscow City Clinical Hospital

Email: exampl@mail.ru

MD, PhD

Russian Federation, 117997, Moscow; 115056, Moscow

Igor’ G. Nikitin

N.I.Pirogov Russian National Research Medical University; Medical and Rehabilitation Center

Email: exampl@mail.ru
ORCID iD: 0000-0003-1699-0881

MD, PhD, DSc, Professor

Russian Federation, 125367, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Pseudo-infarction ECG changes in a 71-year-old patient with AKMP.

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3. Figure 2. Echocardiogram of a patient with AL-amyloidosis, severe pseudohypertrophy of the left ventricle.

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4. Fig. 3. Electrocardiogram of a patient of 80 years with AKMP. QRS low voltage in limb leads and chest leads, LV wall thickness - 1.6 cm.

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5. Fig. 4. Deposits of amyloid in the atrium. Stained with hematoxylin and eosin (A) and Congo red in a bright field (B). SW × 20.

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6. Fig. 5. Deposits of amyloid in the atrium. Congo red stain, polarization microscopy. SW × 20.

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7. Fig. 6. Deposits of amyloid in the myocardium of the left ventricle. Stained with hematoxylin and eosin (A), Congo red - light (B) and polarization (C) microscopy. SW × 20.

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8. Fig. 7. Deposits of amyloid in the thyroid gland. Congo red stain - light (A) and polarization (B) microscopy. SW × 20.

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