Cardiac amyloidosis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]; Aarti Narayan, M.B.B.S [3]; Cafer Zorkun, M.D., Ph.D. [4]; Lakshmi Gopalakrishnan, M.B.B.S. [5]

Cardiac amyloidosis is difficult to diagnose. More than 50% of the patients with cardiac amyloidosis present with signs and symptoms suggestive of right heart failure. Common physical exam findings include elevated jugular venous pressure, third heart sound and pedal edema.

The blood pressure may be low or may drop when rising to a standing position (orthostatic hypotension). Orthostatic hypotension is typically observed among patients with kidney involvement. Low cardiac output and/or inappropriate peripheral vasodilation can also contribute to hypotension.

• Elevated jugular pressure
• Periorbital purpura: Often occurs with sneezing, coughing or with minor trauma. Indicates capillary involvement of AL type amyloidosis.
• Macroglossia
• Abnormal phonation

• Pedal edema

• Hepatomegaly may be present in the setting of right heart failure
• Ascites may be present in the setting of right heart failure
• Splenomegaly is rare

• Third heart sound
• Fourth heart sound
• Arrhythmias ^[1]
• Auscultation may also reveal rales, heart murmurs, and/or other pathologic heart sounds.
• In patients with valvular heart disease involvement, murmurs of mitral and tricuspid regurgitation may be heard.

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