In amyloidosis an abnormal protein is deposited in one or more organs of the body. Deposits in the heart may result in cardiomegaly, heart failure and conduction defects.


Clinical findings:

(1) congestive heart failure, especially without a history of previous heart disease

(2) hepatosplenomegaly

(3) syncope

(4) ischemic syndromes if coronary arteries occluded


Changes in the electrocardiogram seen in amyloidosis:

(1) low voltage in all wave forms in the limb leads (I, II, III, aVL, aVF, aVR)

(2) marked left axis deviation

(2a) left axis deviation: QRS axis from -30° to -90°

(2b) extreme left axis deviation: QRS axis from -90° to -180°

(3) absent (QS) or minimal R waves

(3a) typically in leads V1-V3 or in lead V4

(3b) sometimes loss of R waves in leads II, III and aVF

(4) conduction defects:

(4a) increased P-R interval (first degree AV block)

(4b) intraventricular conduction delay

(4c) left and/or right bundle branch block

(4d) second degree AV block

(5) arrhythmias

(5a) atrial fibrillation

(5b) ventricular premature contractions


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