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Have you been feeling more tired than usual, short of breath, or noticed swelling in your feet or legs? If so, your doctor may have mentioned amyloidosis and ordered an echocardiogram (echo) to check your heart. An echo is a simple, painless test that shows how well your heart is working and whether amyloidosis may be affecting it.
Although it can’t confirm the diagnosis on its own, an echo can help doctors spot changes in heart structure and function. These details are important for diagnosing, estimating how serious the condition might be, and keeping track of your progress over time. This guide will help you understand what an echo is and what the results might mean for you.
An echocardiogram, or echo, uses special sound waves called ultrasound to create pictures of your heart. During an echo, a technician places a small device on your chest that sends out these sound waves. When the sound waves bounce off your heart, they create echoes that turn into live images on a screen. Echo images show your heart’s chambers, valves, and how blood is flowing through your heart.
Cardiac amyloidosis (CA) develops when misfolded proteins, called amyloids, build up in the heart and make the heart muscle weaker. This condition is known as amyloid cardiomyopathy. Several tests help diagnose CA. If your doctor thinks you might have CA, the first step is usually an echo.
When an echo shows signs that might point to CA, healthcare providers will order other tests, such as:
CMR identifies changes in heart structure and function caused by heart amyloid infiltration.
Nuclear cardiac scintigraphy is an imaging test that uses a small amount of radioactive tracer, which is considered safe and commonly used in medicine. This test helps doctors tell the difference between the two main types of amyloidosis that affect the heart:
A PYP scan is a special imaging test that uses a small amount of radioactive material called Tc99m-PYP. This material sticks to the type of amyloid buildup found in ATTR amyloidosis, which helps doctors see signs of the disease more easily.
A heart biopsy is a test where doctors take a small sample of heart tissue to check for amyloid proteins. It’s the most accurate way to confirm CA, which is why it’s called the gold standard. The results are very reliable, with a success rate between 87 percent and 98 percent. But because it involves removing a small piece of heart tissue, it’s more invasive, and there is a small risk of injury. Because amyloidosis can also show up in other parts of the body — like belly fat, under the skin, or the digestive system — doctors may sometimes do a biopsy in one of those areas instead.
Echocardiography, CMR, nuclear cardiac scintigraphy, and biopsy help doctors understand cardiac involvement in amyloidosis, which makes it easier to treat and manage the disease.
Amyloid proteins can build up in different parts of your heart. The heart has four chambers: two upper chambers (atria) and two lower chambers (ventricles). The atria receive blood, and the ventricles pump it out. The left ventricle sends blood to the rest of the body, while the right ventricle sends it to your lungs. Heart valves connect the chambers and help keep blood flowing in the right direction.
If amyloid proteins collect in your heart, it can lead to CA. Doctors look for specific signs to diagnose this condition, including:
Doctors can find these signs on an echocardiogram when trying to diagnose CA. Below, we’ll explain a few of these terms you might read in your medical chart.
When amyloid proteins build up in the left ventricle of your heart, the heart wall (called the myocardium) gets thicker. If it’s thicker than 12 millimeters (mm), it could be a warning sign for CA. But this isn’t always the case — about 1 out of 3 people with the disease don’t have thick walls.
Amyloid deposits can also build up in the right ventricle and the atria. A thicker right ventricle wall — more than 5 mm — can also be a sign, seen with an echocardiogram.
If amyloid proteins make your heart wall thick, your left ventricle (LV) can become stiff (called left ventricular hypertrophy). That makes it hard for the heart to fill and pump blood well. This condition is called diastolic (filling) dysfunction.
Doctors check how much blood your heart pumps out with each beat — this is called ejection fraction. Sometimes, this number looks normal, but the heart still doesn’t work well. When that happens, it’s called heart failure with preserved ejection fraction, and it’s the most common type of heart failure in people with CA. These signs — thickened walls and diastolic dysfunction — can make doctors suspect CA.
If you’re living with CA, it’s important to monitor wall thickness and ejection fraction. A member of MyAmyloidosisTeam shared, “I had another round of tests and an echocardiogram. In my test results, LV wall thickness went down from 16.5 to 12, and my ejection fraction went from 46 percent to 57 percent. These are the bottom of normal, which would be a remarkable improvement. For now, I feel quite good.”
Standard tests like ejection fraction help doctors see how well the heart is pumping. But these tests don’t always show the full picture of how well the heart is pumping. That’s because the heart muscle squeezes in different directions, and sometimes, other patterns of movement may be affected. To check this, doctors use a tool called longitudinal strain. It shows how the heart squeezes from top to bottom. This is a common sign of CA.
Apical sparing is a pattern doctors see on a special heart test called strain imaging. It means the tip of the heart is squeezing more than the base and middle parts. This pattern is a common sign of CA.
When the heart’s ventricles become stiff, pressure builds up inside them. This extra pressure pushes on the walls of the atria, causing them to stretch and get bigger. A large left atrium can be a sign that cardiac amyloidosis is getting worse.
Amyloid proteins can collect in the aortic valve, which is the gate between your heart and your body. This can lead to aortic stenosis, where blood can’t move through the valve well. In some people with CA, the valve is narrow, and blood flow is low. This condition is called low-flow, low-gradient aortic stenosis.
The way CA affects you depends on the kind of amyloidosis you have. An echo test helps doctors watch the disease and see how it’s changing.
A member of the MyAmyloidosisTeam said, “Regular doctor visits are crucial to monitor heart function and track disease progression using tests like echocardiograms, imaging, and biomarkers.”
Echocardiograms can show how well your heart squeezes and pumps blood. This helps doctors understand how serious CA is. Looking at how both the ventricles and atria move, the doctor can gather more information about how the heart works. A 2021 study showed that people with weak heart squeezing in all chambers had a higher chance of dying over four years if they had ATTR or AL amyloidosis.
A term called “stroke volume index” (SVi) shows how much blood your heart pumps to your body, based on your size. In more than 100 people with cardiac ATTR amyloidosis, SVi was a stronger predictor of serious outcomes, like heart failure or death, than other heart measurements.
Treatments for CA depend on the form of the disease. CA therapy aims at managing disease symptoms or treating the underlying amyloidosis. As treatment depends on the type of amyloidosis, an early CA diagnosis is crucial.
An echocardiogram helps doctors see how CA is getting worse and helps them choose the right treatment. If your heart’s left side pumps less, the walls are thicker, and the heart doesn’t fill well, you might have to take medicine to help with heart failure. Echo tests also check how well some CA drugs are working.
To better control CA, healthcare providers advise having repeated echocardiograms at least every six to 12 months.
An echocardiogram can’t confirm if you have CA, but it helps doctors understand the type of heart problem you have, plan your treatment, and monitor how your condition changes over time. It can also detect signs that suggest cardiac amyloidosis, such as thickened heart walls or unusual heart movements, which can lead to further testing.
On MyAmyloidosisTeam, the social network for people with amyloidosis and their loved ones, more than 2,700 members come together to ask questions, give advice, and share their stories with others who understand life with amyloidosis.
Did you get an echo on your road to a diagnosis of cardiac amyloidosis? Share your story by adding a comment below or starting a conversation on MyAmyloidosisTeam.
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