Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Aug 2020
[Suspected cardiac amyloidosis - diagnostic steps for evaluation].
Cardiac amyloidosis is a rare cause of cardiomyopathy, however, it is part of an underdiagnosed underlying systemic disease. For transthyretin (ATTR) amyloidosis, which is caused by the deposition of incorrectly folded transthyretin, either as the wild-type (wtATTR) or mutated (mATTR) form, novel evidence-based treatment options were recently shown to reduce disease progression as well as hospitalisation rates for heart failure. ⋯ Modern non-invasive imaging (cardio magnetic resonance (CMR) and scintigraphic methods) together with immune fixation with determination of free light chains allow fast and reliable clinical screening for cardiac amyloidosis, whereas endomyocardial biopsy and genetics are used for confirmation of the underlying diagnosis. Interdisciplinary teams including hemato-oncology, neurology, nephrology in addition to cardiology are essential to enable personalized targeted treatment strategies.
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24h electrocardiography is an important diagnostic tool in modern cardiology. It has the ability to detect cardiac arrythmias that occur intermittently and therefore can be missed in a standard ECG. However, interpretation of the Holter ECG traces can be difficult and ambiguous. Here, we suggest a step-wise approach to identify all major heart rhythm disorders.