Patient handout

AL (light-chain) cardiac amyloidosis — chronic (cardiology arm)

PRODUCTION

1. Your condition

This handout is for al (light-chain) cardiac amyloidosis — chronic (cardiology arm). Your care team identified this based on: abnormal serum flc ratio / monoclonal on serum or urine immunofixation.

Other reasons your team may use this plan: echo: apical-sparing strain + thick walls + low ecg voltage; disproportionately high nt-probnp / troponin with preserved ef; hf with nephrotic-range proteinuria / orthostatic autonomic features.

3. When to call your provider

Contact your care team if any of the following happen:

Mayo stage IIIb / rapid decompensation → palliative-leaning + attenuated chemo discussion — 2023 ACC amyloid ECDP
Acquired factor-X bleeding before procedure → hematology / factor support — 2023 ACC amyloid ECDP
No monoclonal on work-up → route ATTR engine (do not treat as AL) — Gillmore Circulation 2016

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Mayo stage IIIb (very high natural marker of fluid overload (NT-proBNP) + troponin) — very poor prognosis; attenuated/adapted chemo, early palliative-care integration — 2023 ACC amyloid ECDP(life-threatening)
Acquired factor-X deficiency (amyloid adsorption) — periprocedural bleeding risk; factor support / hematology before invasive procedures — 2023 ACC amyloid ECDP
Concurrent renal AL (nephrotic-range proteinuria / declining eGFR / dialysis) — diuretic-resistant edema, drug dosing, dual-organ staging — 2023 ACC amyloid ECDP
AF or intracardiac thrombus in cardiac AL — anticoagulate regardless of CHA₂DS₂-VASc, balanced against factor-X bleeding — 2023 ACC amyloid ECDP
Advanced cardiac AL otherwise transplant-eligible with controllable clone — heart transplant then clone-directed/SCT sequence at selected centres — 2023 ACC amyloid ECDP
On beta-blocker / ACEi-ARB-ARNi / non-DHP CCB / digoxin — deprescribe (amyloid-specific HF; CCB/digoxin toxic) — 2023 ACC amyloid ECDP

5. Follow-up

Organ-response surveillance, relapse detection (rising dFLC), lifelong amyloid-centre care

6. Sources

Guideline: 2023 ACC Cardiac Amyloidosis Expert Consensus Decision Pathway + ANDROMEDA (Dara-VCd) + revised Mayo/European staging