Medical treatment of CHF due to amyloidosis

Q: Which of the following drugs should be use with caution in cardiac Amyloidosis?

A) Digoxin
B) ACE inhibitors 
C) Angiotensin II inhibitors 
D) Calcium channel blockers (CCB)
E) All of the above


Answer: E

Medical management of heart failure due to cardiac amyloidosis is very difficult as most drugs have high risk profile.

Digoxin can be the biggest culprit as it binds to amyloid fibrils and may quickly culminate patient into "Dig. toxicity"(Choice A). Both ACE inhibitors and angiotensin II inhibitors can induce profound and life-threatening hypotension even with lowest dose (Choices B and C). CCB can cause a significant negative inotropic effect (Choice D).

Mainstay of treatment in cardiac amyloidosis is diuretic.


#cardiology


Reference:

Falk R. Diagnosis and management of the cardiac amyloidoses. Circulation 112, 2047–2060 (2005).