Wild-type (senile) amyloidosis differential diagnosis: Difference between revisions
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==Differentiating Wild-type (Senile) Amyloidosis from other Diseases== | ==Differentiating Wild-type (Senile) Amyloidosis from other Diseases== | ||
==== Differentials Based on Cardiac Involvement (Heart Failure) ==== | |||
Cardiac amyloidosis (AL and TTRwt) should be differentiated from other causes of heart failure: | |||
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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}} | |||
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: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 | |||
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* 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 /> | |||
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* 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 | |||
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* 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]] | |||
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:[[Cardiac sarcoidosis]] | |||
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*Asymptomatic conduction abnormalities | |||
*Chest pain | |||
*Congestive heart failure symptoms: | |||
**Fatigue | |||
**Syncope | |||
**Dyspnea | |||
**Chest pain. | |||
**Irregular heartbeats | |||
**Palpitations | |||
**edema<br /> | |||
** | |||
** | |||
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* Ventricular tachyarrhythmia | |||
* Heart block | |||
* Valvular regurgitation | |||
* Pericardial effusion | |||
* Constrictive pericarditis or temponade | |||
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* Serum markers that have been reported as markers of sarcoidosis in general are: | |||
**Serum amyloid A (SAA) | |||
**Soluble interleukin-2 receptor (sIL-2R) | |||
**Lysozyme | |||
**Angiotensin-converting enzyme (ACE) | |||
**Gycoprotein KL-6 | |||
**Hypercalcemia | |||
**Hypercalciuria | |||
**(noncaseating granulomas secrete 1,25 vitamin D) | |||
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*Radionuclide examinations | |||
**Thallium‐201 scintigraphy | |||
**Gallium‐67 scintigraphy | |||
**Positron emission tomography | |||
*Magnetic resonance imaging | |||
*Samples of myocardium with sarcoidosis shows the following: | |||
*Non‐caseating, multinucleated giant cell granuloma in the subendocardium | |||
*Trichrome stain can show a dense band of collagen fibers, encasing aggregate of granulomas and inflammatory cells | |||
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:ST Segment Elevation Myocardial Infarction | |||
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*Chest pain with possible radiation to left arm and lower jaw | |||
*Squeezing, crushing chest pain | |||
*Sweating | |||
*Nausea and vomiting | |||
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*Anxious patient in pain with diaphoresis | |||
*Signs of heart failure may be present | |||
*Arrhythmia | |||
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* ST elevation, new left bundle branch block, and Q wave on EKG | |||
* Elevated cardiac biomarkers | |||
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*Either complete or subtotal occlusion of an epicardial coronary artery on coronary angiography | |||
*Confluent hyperenhancement extending from the endocardium | |||
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:Non ST Elevation Myocardial Infarction | |||
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*Crushing, left-sided substernal chest pain or pressure that radiates to the neck or left arm | |||
* | |||
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*Same as ST-elevation MI | |||
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* ST-segment depression or T-wave inversion on EKG | |||
* Elevated cardiac biomarkers | |||
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* | |||
* | |||
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:Pericarditis | |||
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*Chest pain relieved by sitting up and leaning forward and worsened by lying down | |||
*Fever, anxiety, difficulty breathing | |||
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*Pericardial friction rub | |||
*Signs of cardiac tamponade may be present | |||
* | |||
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*PR segment depression and electrical alternans on EKG | |||
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*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 | |||
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:Alcoholic Cardiomyopathy | |||
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*History of alcohol abuse | |||
*Fatigue, weakness, anorexia, palpitations, and shortness of breath on activity | |||
*Leg swelling and pedal edema | |||
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*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 | |||
* | |||
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*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 | |||
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*Cardiomegaly, pulmonary congestion, and pleural effusions on CXR | |||
*Left ventricular dilatation on echo | |||
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==References== | ==References== |
Revision as of 20:30, 19 December 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Differentiating Wild-type (Senile) Amyloidosis from other Diseases
Differentials Based on Cardiac Involvement (Heart Failure)
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 |
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Periorbital purpura: Often occurs with sneezing, coughing or with minor trauma. Indicates capillary involvement of AL type amyloidosis.
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