In this episode, host Dr Krystyna De Lange speaks with Sydney-based cardiologist Dr Natasha Gorrie from St Vincent's Hospital and the Victor Chang Cardiac Research Institute. They discuss cardiac amyloidosis, an under-recognised cause of heart failure in older adults and a condition with evolving diagnostic and treatment approaches.

Dr Natasha Gorrie outlines the basics of amyloidosis, emphasising that it is an umbrella term for disorders characterised by the deposition of abnormal protein fibrils in tissues and organs.

Key Points:

• Understanding Amyloidosis: The pathology and range of organ involvement; why diagnosis depends on identifying the causative protein.
• Epidemiology and Prevalence: Recent recognition that transthyretin-related amyloidosis (ATTR) is more common than previously thought, with prevalence as high as one in six in certain heart failure populations.
• Key Clinical Clues: Red flag features in patients (particularly those over the age of 65), including heart failure with preserved ejection fraction, left ventricular wall thickening, atrial fibrillation, aortic stenosis, carpal tunnel syndrome, and unexplained changes in blood pressure medication requirements.
• Diagnostic Pathway: The importance of timely suspicion, appropriate specialist referral, and the role of the monoclonal screen (serum and urine electrophoresis and serum free light chains) to rule out AL (light chain) amyloidosis. The role of bone scintigraphy and when tissue biopsy is indicated.
• Therapeutic Options: Overview of disease-modifying treatments available for different amyloid subtypes, including the PBS-approved medication tafamidis for ATTR cardiac amyloidosis.
• The GP’s Role: GPs are essential for early suspicion, referral, initiation of screening tests, and, following diagnosis, ongoing care; including regular review, heart failure management, coordination of multidisciplinary care, and supporting the patient’s mental health and quality of life.

Dr. Natasha Gorrie also highlighted an upcoming Australian Prescriber article (due for publication mid 2026) on cardiac amyloidosis, which expands on today’s discussion with practical flowcharts and insights into the central role of GPs. Well worth checking out! https://australianprescriber.tg.org.au/

Links & Resources:

• St Vincents Heart Health Amyloidosis page: https://www.svhhearthealth.com.au/conditions/cardiac-amyloidosis
• Australian Amyloidosis Network: https://aan.org.au

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