Specialized Care for Amyloidosis of the Heart
Cardiac amyloidosis is a serious condition that develops when an abnormal protein called "amyloid" builds up in your heart, interfering with its ability to pump blood effectively. There are two main types of cardiac amyloidosis, based on the type of protein involved:
- Light chain or AL amyloidosis
- Transthyretin amyloidosis or ATTR
The buildup of amyloid deposits in your heart can lead to heart failure. NewYork-Presbyterian offers specialized expertise in the care of people with heart failure due to cardiac amyloidosis. Our team will create a regimen of therapy that is personalized to your needs.
Symptoms & Complications of Cardiac Amyloidosis
Some people with cardiac amyloidosis develop an abnormal heart rhythm called atrial fibrillation, which dramatically increases the risk of stroke. It is vital that these patients receive blood thinners to reduce their stroke risk. Other possible symptoms and complications include:
- Lightheadedness/passing out
- Difficulty urinating
- Heat or cold intolerance
- Abnormal sweating
- Pain in the hands and feet from nerve damage
How We Diagnose Cardiac Amyloidosis
Because cardiac amyloidosis is often mistaken for other conditions like heart disease, it is essential that you see an experienced doctor to determine the cause of your symptoms. The longer cardiac amyloidosis remains untreated, the more your heart function can decline. At NewYork-Presbyterian, we use a combination of tests to diagnose cardiac amyloidosis accurately.
- AL amyloidosis requires a biopsy to make the diagnosis. The biopsy does not need to be from the heart, but a heart biopsy is the best way to diagnose this form of amyloidosis.
- ATTR can be diagnosed using a combination of blood tests and a heart scan called a PYP (pyrophosphate) scan. Biopsies are also sometimes also needed.
Cardiac Amyloidosis Treatment
NewYork-Presbyterian has internationally known programs for amyloidosis. Columbia University Irving Medical Center is a Center of Excellence for Cardiac Amyloidosis and features one of the largest cardiac amyloidosis programs in the country. Weill Cornell Medicine also features multidisciplinary expertise for people with amyloidosis. In addition to access to state-of-the-art treatments, we offer promising new therapies through clinical trials.
Your treatment will depend on the type of amyloidosis you have. Your doctors will let you know if you may be eligible to participate in a clinical trial.
AL amyloidosis is treated with chemotherapy to stop the cell that is producing the abnormal protein, called the plasma cell. There are also many medications to treat AL cardiac amyloidosis. These medications are given by a hematologist-oncologist. ATTR cardiac amyloidosis is treated with an innovative oral medication called tafamidis, which prevents the protein from changing to an abnormal form that can get stuck in the heart.
Many patients with ATTR develop a slowing of the electrical system in the heart and require a permanent pacemaker. The pacemaker enables the heart to beat normally.
In rare cases, a person with cardiac amyloidosis that is not effectively controlled with other therapies may need a heart transplant. Most centers in the United States will not consider a heart transplant for someone with cardiac amyloidosis—but at NewYork-Presbyterian/Columbia, we do. We are home to one of the largest heart transplant programs in the country, with outcomes for cardiac amyloidosis patients that match those of patients having heart transplantation for other reasons.
Pioneering New Cardiac Amyloidosis Therapies through Research
Columbia University has been at the forefront of developing therapies for ATTR. Our investigators led the pivotal study of tafamidis for cardiac amyloidosis, which was approved by the U.S. Food and Drug Administration in May 2019. Our physicians have the longest and largest experience in the use of tafamidis for ATTR. Today researchers at both Columbia University and Weill Cornell Medicine are partnering to lead late-phase clinical trials of other novel therapies for this type of cardiac amyloidosis, with the goal of developing more effective options for patients.