Amyloidosis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

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:

• Acute myocarditis
• Bechterew's Disease
• Bronchiectasis
• Carpal Tunnel Syndrome
• Collagen Vascular Disease
• Drug/toxic nephropathy
• Familial Mediterranean Fever
• Glomerulonephritis
• Hemodialysis Amyloidosis
• Interstitial lung diseases
• Leprosy
• Monoclonal gammopathies
• Multiple Myeloma
• Myocardial fibrosis
• Nephrotic Syndrome
• Osteomyelitis
• Peripheral neuropathy
• Restrictive cardiomyopathy
• Rheumatoid Arthritis
• Rheumatoid Polyarteritis
• Syphilis
• Systemic Lupus Erythematosus
• Tuberculosis
• Ulcerative colitis
• Vitamin deficiencies

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
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