The main goal of treatment for cardiac amyloidosis is to:
- Manage the heart problems caused by the abnormal protein deposits (for example, heart failure when the heart isn’t able to pump well enough to meet the body’s need and heart rhythm issues such as atrial fibrillation).
- Try to stop or slow protein deposits, though the treatment used will depend on your type of amyloidosis.
Many treatments are currently being studied in clinical trials. Ask your doctor if a clinical trial is available. Participating may give you access to the latest therapies.
When it comes to your heart health, your care team may talk with you about:
- Making changes to your diet, including limiting how much salt, or sodium, you consume.
- Weighing yourself every morning, ideally before breakfast, and alerting them if you gain 3 pounds within 24 hours or 5 pounds within a week. Rapid weight gain is a red flag that fluid is building up in your body.
- Taking a diuretic (water pill) if your body is holding on to extra water or fluid. It’s important to work with your care team and find a diuretic that works for you. There isn’t a one-size-fits-all approach, so be sure to let your care team know how you are doing.
- Monitoring your heart rhythm to see if your heart is beating unevenly, too fast, or too slow. Many people with cardiac amyloidosis will one day need a pacemaker. It’s important to identify and try to treat abnormal heart rhythms early on.
- Heart medicines such as blood thinners, angiotensin-receptor agonists and beta blockers may be prescribed, but some need to be used with caution. Certain medications can lead to dangerous drops in blood pressure and other health issues. Calcium channel blockers are not recommended for people with amyloid heart disease.
- Managing other conditions, including getting to a healthy blood pressure.
- Heart transplantation for some patients with very poor heart function.
To help control or slow amyloid deposits, treatments vary and may include:
For light chain (AL) amyloidosis
- Plasma cell directed therapy
- Chemotherapy combined with steroids and/or immunotherapy
- Stem cell transplant along with high-dose chemotherapy
A hematologist, a doctor with special training in blood disorders, often takes the lead in managing AL together with a cardiologist.
For transthyretin (ATTR or TTR) amyloidosis
- Medications can help control or slow ATTR, but they won’t cure it. These may include:
- Tafamidis, which stabilizes the transthyretin protein to help keep it from misfolding or breaking apart; this helps prevent the protein from depositing in the heart
- Inotersen or patisiran may be used if you have the variant type of ATTR that affects the nerves; these medications are being studied in other patients, but they are not yet approved for more general use
- Many other medications are being studied in clinical trials. For example, gene-silencing drugs that aim to stop or reduce the production of TTR in the liver and prevent amyloid buildup and organ damage.
- Heart or liver transplant for some select people
Learn more: Different types of amyloidosis
It’s very important to take your medications exactly as your care team tells you.