CARDIAC AMYLOIDOSIS: PRINCIPLES, DIAGNOSIS, AND MANAGEMENT

Heart failure with preserved ejection fraction. Unexplained left ventricular thickening. Low voltage on ECG that doesn’t match the echo. Bilateral carpal tunnel syndrome years before cardiac symptoms. What if we have been missing the diagnosis? Cardiac amyloidosis is no longer a medical curiosity. With advances in imaging, molecular typing, and transformative therapies for both AL (light chain) and ATTR (transthyretin) amyloidosis, early recognition is now lifesaving. Yet many clinicians still encounter delayed diagnoses, therapeutic uncertainty, and fragmented care pathways. CARDIAC AMYLOIDOSIS: PRINCIPLES, DIAGNOSIS, AND MANAGEMENT is a comprehensive, clinically grounded, and future-focused reference designed to change that. This book takes readers from first principles to cutting-edge innovation in a structured, clinically intuitive journey: Foundations: From Misfolded Protein to Failing Heart The history of amyloidosis—from Virchow’s early observations to modern molecular breakthroughs Mechanisms of protein misfolding, fibrillogenesis, and organotropism Why the heart becomes the target organ Chemical classification and the crucial distinction between AL and ATTR Epidemiology, racial disparities, and genetic penetrance Clinical Suspicion: Recognizing the “Red Flags” The mismatch between ECG voltage and wall thickness HFpEF as a common masquerade Orthopedic clues: carpal tunnel, spinal stenosis, tendon rupture Autonomic dysfunction and extracardiac manifestations A practical differential diagnosis including HCM, Fabry disease, sarcoidosis, and more Imaging Mastery ECG patterns and conduction disease Transthoracic echo basics and advanced strain imaging (the classic “apical sparing” pattern) Cardiac MRI with T1 mapping and Late Gadolinium Enhancement Nuclear scintigraphy with Tc-99m PYP and Perugini grading SPECT/CT and PET tracers in clinical and research settings Diagnostic Precision Biomarker staging systems (Mayo, Gilmore) Monoclonal protein screening algorithms Extracardiac and endomyocardial biopsy techniques Congo Red staining, immunohistochemistry pitfalls, and laser microdissection mass spectrometry—the gold standard Disease-Specific Management The urgency of AL amyloidosis and modern chemotherapy regimens Stem cell transplantation and relapsed disease strategies ATTR therapies: TTR stabilizers, RNA silencers, and gene editing Emerging anti-amyloid degraders and CRISPR-based approaches Practical Cardiology in Amyloid Patients Fluid management within a narrow therapeutic window Medications to avoid—and why Atrial fibrillation, anticoagulation, and device therapy ICD controversies and shared decision-making Mechanical circulatory support and transplant considerations Beyond the Heart Neurologic, renal, and gastrointestinal management Financial toxicity and patient advocacy Palliative care integration Building a multidisciplinary amyloid center The future of AI-driven screening and personalized medicine This is more than a textbook—it is a clinical playbook. Whether you are: A cardiologist managing unexplained HFpEF A hematologist treating plasma cell dyscrasia An internist encountering subtle red flags A cardiac imager refining diagnostic algorithms A trainee seeking structured mastery Or a healthcare system leader building an amyloid program