Heart Failure: An Unexpected Cause

Heart failure remains one of the most significant causes of death globally. When people think of it, they usually associate it with clogged arteries or heart attacks. Yet, there’s another less common culprit that may be overlooked.

Recently, cardiologist Dmitry Yaranov unveiled a surprising risk factor that many aren’t aware of. He stated, “It’s not blocked arteries. Not high blood pressure. Not a heart attack.” Many patients receive misdiagnoses for years, often told they have “hypertension,” “age-related issues,” or simply “back pain.” Meanwhile, their heart condition silently worsens.

So, what’s this hidden threat? Yaranov points to amyloidosis—a condition where abnormal proteins infiltrate the heart, making it stiffer and leading to heart failure. Most Americans are unfamiliar with cardiac amyloidosis, yet it’s increasingly recognized as a potential cause of heart failure, particularly among older individuals. In essence, amyloidosis involves misfolded proteins (known as amyloid) accumulating in organs, including the heart, which hinders its ability to pump blood effectively. Doctors say this is often overlooked and can resemble more common diagnoses like heart failure with preserved ejection fraction (HFpEF), atrial fibrillation, or hypertensive heart disease.

Understanding Amyloidosis

Amyloidosis is characterized by the improper folding of proteins, called amyloid fibrils, which accumulate in various tissues and organs. In the case of cardiac amyloidosis, the heart is particularly affected, though other organs like the kidneys and liver can also be involved. When amyloidosis targets the heart, conditions can deteriorate rapidly.

The two primary types impacting the heart include:

• AL Amyloidosis: Arises from abnormal plasma cells in the bone marrow that generate misfolded light chain proteins.
• ATTR Amyloidosis: Stems from a faulty transthyretin (TTR) protein, either due to genetic factors (hereditary) or aging (wild-type).

The Impact of Cardiac Amyloidosis on Heart Function

Imagine the heart muscles as elastic bands that stretch and contract with each heartbeat. Amyloid deposits result in these bands becoming stiff and inflexible. Instead of growing muscle, the heart walls thickening is due to protein buildup. Consequently, the heart cannot fill properly, leading to diastolic dysfunction, and eventually struggles to pump out sufficient blood (systolic dysfunction).

Common symptoms of cardiac amyloidosis include:

• Shortness of breath, particularly during exertion or when lying down
• Swelling in the legs, ankles, or abdomen
• Fatigue or weakness
• Dizziness or fainting
• Irregular heartbeat, commonly atrial fibrillation
• Chest pressure or a feeling of fullness
• Fluid retention and weight gain associated with water retention

These symptoms often mirror those of heart failure, which is why many cases of amyloidosis go undiagnosed, especially in older adults. Yaranov cautions, “This isn’t rare. It’s just rarely diagnosed. For many patients, early recognition is the only chance for a better outcome.”