Hypertrophic and restrictive cardiomyopathies in the elderly

RCM should be considered in older patients with marked fluid retention, conduction abnormalities, and a normal to small left ventricular cavity with usually normal systolic function. In contrast to early diastolic relaxation impairment seen in hypertrophic disease, signs and symptoms of RCM are caused by compromise in late diastole. Although amyloid is a frequent finding in older hearts at autopsy, most deposits are confined to the atria and are of little clinical significance. Of the pathologic types of amyloidosis, immunoglobulin light chain amyloid most commonly infiltrates the heart and carries the worst prognosis (although survival is slightly better in older than younger patients). Familial amyloidosis is an example of a genetic disease of late-onset phenotypic expression with growing importance in the elderly? Familial amyloidosis carries a more favorable prognosis stressing the significance of accurately diagnosing the type of amyloid by serum immunohistochemistry. The terms systemic senile amyloidosis and senile cardiac amyloidosis have been broadly used to describe the age-related increase in amyloid deposits, regardless of the protein subtype. Normal and genetically altered transthyretin have been identified as the protein precursors of these disorders, reclassifying them as a subset of familial amyloidosis. Symptomatic treatment with diuretics remains the goal of therapy with careful titration to avoid hypotension.