Amyloidosis differential diagnosis: Difference between revisions

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{{Amyloidosis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Amyloidosis#Overview]]
{{CMG}}
{{CMG}}; {{AE}} {{HK}}


== Overview ==
== Overview ==
Amyloidosis needs to be differentiated from acute [[myocarditis]], [[bronchiectasis]], [[multiple myeloma]] and other systemic diseases .
Amyloidosis needs to be differentiated from systemic diseases including [[acute myocarditis]], [[bronchiectasis]], and [[multiple myeloma]].
 
==Differentiating Amyloidosis from other Diseases ==
==Differentiating Amyloidosis from other Diseases ==
Amyloidosis should be differentiated from the following systemic diseases:
Amyloidosis should be differentiated from the following systemic diseases:
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* [[Ulcerative colitis]]
* [[Ulcerative colitis]]
* Vitamin deficiencies
* Vitamin deficiencies
==Cardiac Amyloidosis==
Cardiac amyloidosis (AL and TTRwt) should be differentiated from other causes of heart failure:
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align=center
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|History and Symptoms}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Physical Examination}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Laboratory Findings}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Imaging Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:Cardiac amyloidosis
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* [[Fatigue]]
* [[Dyspnea]]
* [[Dizziness]]
* [[Orthopnea]]
* [[Peripheral edema]]
* [[Weight loss]] due to cardiac cachexia
* [[Ascites]]
* [[Syncope]] on [[exertion]]
* [[Transthyretin]] (TTR) associated more common in African-Americans during sixth to seventh decade of life
| style="padding: 5px 5px; background: #F5F5F5;" |
* Elevated jugular pressure
Periorbital purpura: Often occurs with sneezing, coughing or with minor trauma. Indicates capillary involvement of AL type amyloidosis.
* Macroglossia
* Abnormal phonation
* Hepatomegaly
* Ascites may be present in the setting of heart failure
* Valvular involvement murmurs of mitral and tricuspid regurgitation (systolic). <br />
<br />
| style="padding: 5px 5px; background: #F5F5F5;" |
* Normocytic mormochromic anemia
* Serum free-light-chain assay positive
* Increased BNP, ANP and β2 microglobulin
* Voltage-to-mass ratio is more sensitive than EKG, 2D Echo and nuclear scanning alone
| style="padding: 5px 5px; background: #F5F5F5;" |
* Granular or sparkling appearance of the [[left ventricular]] (LV) [[myocardium]]
* Increased [[Atria|left and right atrial]] volumes and reduced atrial function on [[cardiac MRI]]
* [[Interatrial septum|Atrial septal]] thickening
* Dynamic LV flow
* Mildly or moderately increased wall thickness in the early [[asymptomatic]] phase and severe thickening and [[hypokinesia]] of the [[left ventricular]] posterior wall and [[interventricular septum]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:ST Segment Elevation Myocardial Infarction
| style="padding: 5px 5px; background: #F5F5F5;" |
*Chest pain with possible radiation to left arm and lower jaw
*Squeezing, crushing chest pain
*Sweating
*Nausea and vomiting
| style="padding: 5px 5px; background: #F5F5F5;" |
*Anxious patient in pain with diaphoresis
*Signs of heart failure may be present
*Arrhythmia
| style="padding: 5px 5px; background: #F5F5F5;" |
* ST elevation, new left bundle branch block, and Q wave on EKG
* Elevated cardiac biomarkers
| style="padding: 5px 5px; background: #F5F5F5;" |
*Either complete or subtotal occlusion of an epicardial coronary artery on coronary angiography
*Confluent hyperenhancement extending from the endocardium
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Non ST Elevation Myocardial Infarction
| style="padding: 5px 5px; background: #F5F5F5;" |
*Crushing, left-sided substernal chest pain or pressure that radiates to the neck or left arm
*
| style="padding: 5px 5px; background: #F5F5F5;" |
*Same as ST-elevation MI
| style="padding: 5px 5px; background: #F5F5F5;" |
* ST-segment depression or T-wave inversion on EKG
* Elevated cardiac biomarkers
| style="padding: 5px 5px; background: #F5F5F5;" |
*
*
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Pericarditis
| style="padding: 5px 5px; background: #F5F5F5;" |
*Chest pain relieved by sitting up and leaning forward and worsened by lying down
*Fever, anxiety, difficulty breathing
| style="padding: 5px 5px; background: #F5F5F5;" |
*Pericardial friction rub
*Signs of cardiac tamponade may be present
*
| style="padding: 5px 5px; background: #F5F5F5;" |
*PR segment depression and electrical alternans on EKG
| style="padding: 5px 5px; background: #F5F5F5;" |
*A flask-shaped, enlarged cardiac silhouette on CXR
*Pericardial thickness of more than 4 mm on MRI
*Pericardial effusion and cardiac chamber indentation or collapse on echo when cardiac tamponade is present
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Alcoholic Cardiomyopathy
| style="padding: 5px 5px; background: #F5F5F5;" |
*History of alcohol abuse
*Fatigue, weakness, anorexia, palpitations, and shortness of breath on activity
*Leg swelling and pedal edema
| style="padding: 5px 5px; background: #F5F5F5;" |
*Signs of heart failure such as presence of S3 and S4 heart sounds, pedal edema, and jugular venous distension
*Signs of alcoholic liver disease may be present
*
| style="padding: 5px 5px; background: #F5F5F5;" |
*Elevated MCV and MCHC on CBC
*Elevated LDH, AST, ALT, creatine kinase, gammaglutamyl transpeptidase, malic dehydrogenase, and alpha-hydroxybutyric dehydrogenase
*Q waves and non specific ST and T wave changes on EKG
| style="padding: 5px 5px; background: #F5F5F5;" |
*Cardiomegaly, pulmonary congestion, and pleural effusions on CXR
*Left ventricular dilatation on echo
|-
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|-
|}


== References ==
== References ==
{{reflist|2}}
{{reflist|2}}


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[[Category:Disease]]
[[Category:Disease]]
[[Category:Rheumatology]]
[[Category:Rheumatology]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Mature chapter]]
[[Category:Metabolic disorders]]
[[Category:Inborn errors of metabolism]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
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{{WS}}

Latest revision as of 03:30, 28 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Amyloidosis needs to be differentiated from systemic diseases including acute myocarditis, bronchiectasis, and multiple myeloma.

Differentiating Amyloidosis from other Diseases

Amyloidosis should be differentiated from the following systemic diseases:

Cardiac Amyloidosis

Cardiac amyloidosis (AL and TTRwt) should be differentiated from other causes of heart failure:

Differential Diagnosis History and Symptoms Physical Examination Laboratory Findings Imaging Findings
Cardiac amyloidosis
  • Elevated jugular pressure

Periorbital purpura: Often occurs with sneezing, coughing or with minor trauma. Indicates capillary involvement of AL type amyloidosis.

  • Macroglossia
  • Abnormal phonation
  • Hepatomegaly
  • Ascites may be present in the setting of heart failure
  • Valvular involvement murmurs of mitral and tricuspid regurgitation (systolic).


  • Normocytic mormochromic anemia
  • Serum free-light-chain assay positive
  • Increased BNP, ANP and β2 microglobulin
  • Voltage-to-mass ratio is more sensitive than EKG, 2D Echo and nuclear scanning alone
ST Segment Elevation Myocardial Infarction
  • Chest pain with possible radiation to left arm and lower jaw
  • Squeezing, crushing chest pain
  • Sweating
  • Nausea and vomiting
  • Anxious patient in pain with diaphoresis
  • Signs of heart failure may be present
  • Arrhythmia
  • ST elevation, new left bundle branch block, and Q wave on EKG
  • Elevated cardiac biomarkers
  • Either complete or subtotal occlusion of an epicardial coronary artery on coronary angiography
  • Confluent hyperenhancement extending from the endocardium
Non ST Elevation Myocardial Infarction
  • Crushing, left-sided substernal chest pain or pressure that radiates to the neck or left arm
  • Same as ST-elevation MI
  • ST-segment depression or T-wave inversion on EKG
  • Elevated cardiac biomarkers
Pericarditis
  • Chest pain relieved by sitting up and leaning forward and worsened by lying down
  • Fever, anxiety, difficulty breathing
  • Pericardial friction rub
  • Signs of cardiac tamponade may be present
  • PR segment depression and electrical alternans on EKG
  • A flask-shaped, enlarged cardiac silhouette on CXR
  • Pericardial thickness of more than 4 mm on MRI
  • Pericardial effusion and cardiac chamber indentation or collapse on echo when cardiac tamponade is present
Alcoholic Cardiomyopathy
  • History of alcohol abuse
  • Fatigue, weakness, anorexia, palpitations, and shortness of breath on activity
  • Leg swelling and pedal edema
  • Signs of heart failure such as presence of S3 and S4 heart sounds, pedal edema, and jugular venous distension
  • Signs of alcoholic liver disease may be present
  • Elevated MCV and MCHC on CBC
  • Elevated LDH, AST, ALT, creatine kinase, gammaglutamyl transpeptidase, malic dehydrogenase, and alpha-hydroxybutyric dehydrogenase
  • Q waves and non specific ST and T wave changes on EKG
  • Cardiomegaly, pulmonary congestion, and pleural effusions on CXR
  • Left ventricular dilatation on echo

References

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