Which physical findings are characteristic of cardiac amyloidosis?

Updated: Mar 25, 2020
  • Author: Gyanendra K Sharma, MD, FACC, FASE; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Physical examination findings in primary amyloidosis are consistent with features of right-sided heart failure and includes elevated jugular venous pressure, right-sided third heart sound, and lower extremity edema. A prominent fourth heart sound is present in patients without atrial fibrillation.

Periorbital purpura and macroglossia are specific for the presence of disease but have poor sensitivity (10-20%). Abnormal phonation resulting in a change in speech quality is seen in most cases and may be an early feature of systemic amyloidosis. [37] Visceral involvement may result in the enlargement of liver and kidneys. Ascites and pleural effusion may be present. The patient may present with bilateral carpel tunnel syndrome or painful peripheral neuropathy.

Hypotension may be from low cardiac output or autonomic neuropathy. Murmurs of tricuspid or mitral regurgitation may be present in patients with valvular infiltration of amyloid.

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