Cardiac amyloidosis is not one disease and should not be treated as a generic heart-failure diagnosis. The most important first step is to establish the amyloid type and the extent of cardiac and systemic involvement. ATTR amyloidosis and light-chain (AL) amyloidosis have different diagnostic and treatment pathways, and an international patient should not travel for a cardiac procedure or disease-specific drug plan before the type has been clarified by an experienced multidisciplinary team.
Separate ATTR from AL amyloidosis before choosing treatment
The diagnostic sequence should distinguish transthyretin amyloidosis from light-chain amyloidosis because management and urgency differ. Cardiac imaging is interpreted together with laboratory testing for a monoclonal protein and, where appropriate, bone-tracer scintigraphy, tissue analysis and genetic evaluation.
- Clinical history and examination for cardiac and extracardiac red flags
- ECG and echocardiography
- Cardiac MRI when clinically useful
- Serum and urine assessment for a monoclonal protein / light-chain disorder
- Bone-tracer scintigraphy or SPECT in an appropriate ATTR diagnostic pathway
- Biopsy when non-invasive testing does not establish the diagnosis or another type remains possible
- TTR genetic testing when hereditary ATTR is possible
ATTR cardiac amyloidosis has its own disease-specific pathway
Once ATTR cardiac amyloidosis is established, the specialist team assesses whether the disease is wild-type or hereditary, the degree of cardiac involvement and whether disease-modifying therapy is appropriate. Treatment planning also includes management of congestion, rhythm problems, blood pressure and other organ involvement.
Suspected AL amyloidosis requires hematology involvement
AL amyloidosis is a systemic light-chain disorder and should be coordinated with hematology rather than managed as an isolated cardiology problem. Cardiac involvement affects risk and treatment planning, but the disease-directed therapy targets the underlying plasma-cell clone and requires a different multidisciplinary pathway from ATTR amyloidosis.
Heart-failure and rhythm management must be adapted to the amyloidosis phenotype
Congestion, atrial arrhythmias, conduction disease and low blood pressure can complicate cardiac amyloidosis. Medication and device decisions therefore require specialist review rather than automatic transfer of a standard heart-failure regimen from another cardiomyopathy.
Send enough records for a remote specialist review
An international center needs the evidence used to suspect or establish amyloidosis, not only the label 'cardiac amyloidosis'.
- Echocardiography images and report
- Cardiac MRI images/report if performed
- Bone scintigraphy/SPECT images and report if performed
- Serum and urine immunofixation and free-light-chain results when available
- Biopsy and pathology/typing report if tissue was sampled
- Genetic test results if already available
- Recent kidney/liver tests and cardiac biomarkers
- Current medication and rhythm history
- Neurologic, renal or other systemic amyloidosis findings
Sources and review
This guide was last source-reviewed on 2026-08-31.
- 2023 ESC Guidelines for the management of cardiomyopathies — European Society of Cardiology ↗
- Cardiac amyloidosis clinic — University Medical Center Hamburg-Eppendorf (UKE) ↗
- Amyloidosis cardiology clinic — Heidelberg University Hospital ↗
- Amyloidosis consultation – cardiac amyloidosis — Deutsches Herzzentrum der Charité ↗