Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is a rare but serious heart disease that disproportionately affects older adults. This condition occurs when faulty proteins build up in the heart, causing it to stiffen and struggle to pump efficiently. Because its symptoms mimic common signs of aging, ATTR-CM often goes undiagnosed for too long, leading to declining health and a reduced quality of life.
What is ATTR-CM?
ATTR-CM happens when the transthyretin (TTR) protein, normally found in the blood, misfolds and deposits in the heart muscle. This buildup thickens the heart walls, making it harder to fill with blood and pump effectively. There are two types: hereditary, caused by a genetic mutation, and wild-type, which develops spontaneously with age. Both typically manifest after age 50.
Why this matters: ATTR-CM isn’t just a heart condition; it impacts multiple organs and functions, making early diagnosis critical. Without treatment, the average lifespan after diagnosis is only five to seven years.
Recognizing the Symptoms: Aging vs. ATTR-CM
The biggest challenge with ATTR-CM is its subtle onset. Symptoms are often mistaken for normal age-related decline:
- Unexplained fatigue: Feeling tired even after rest.
- Dizziness: Especially when standing up quickly.
- Shortness of breath: Particularly with exertion.
- Leg swelling: Fluid buildup in the lower extremities.
If these symptoms appear, worsen, or interfere with daily life, seek medical attention. More severe signs include breathlessness at rest, abdominal swelling, palpitations, or fainting spells – these indicate a need for immediate reevaluation of treatment.
Managing Frailty and Mobility Loss
ATTR-CM accelerates frailty, a state of increased vulnerability to illness and disability. Studies show that over half of older adults with ATTR-CM are frail, which significantly increases their risk of death regardless of other health factors.
The stiffening of the heart muscle reduces blood flow, depriving muscles of oxygen and nutrients. This leads to fatigue, shortness of breath, and decreased mobility. However, supervised exercise programs—like those in cardiac rehabilitation—can help strengthen muscles and improve heart function. Low-impact activities (walking, swimming, light gardening) are often more manageable.
Important note: Consult your doctor before starting any exercise program. If frailty is severe, palliative care may be the most appropriate approach. Assistive devices (canes, walkers, grab bars) can also improve safety and independence.
Nutrition for Strength and Endurance
Older adults with ATTR-CM are at higher risk of weight loss and malnutrition. A balanced diet rich in lean proteins, healthy fats, whole grains, and colorful vegetables is crucial. Sodium and fluid intake should be carefully monitored to prevent heart failure symptoms from worsening.
Vitamin D and calcium supplementation may also be beneficial, as bone loss is common in aging populations. Eating smaller, more frequent meals can prevent blood pressure drops that cause dizziness after larger meals.
Medication Review: Avoiding Harmful Interactions
Many older adults take multiple medications (polypharmacy). Some drugs commonly used for conditions like high blood pressure or arthritis can worsen ATTR-CM symptoms. Medications to discuss with your doctor include alpha-blockers, ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, diuretics, and NSAIDs.
Bring a complete medication list to every appointment and ask whether any drugs could be contributing to fatigue, dizziness, or shortness of breath. If a medication is essential, explore alternatives with your doctor. Never stop taking prescribed drugs without professional guidance.
Quality of Life, Mental Health, and End-of-Life Planning
Symptoms of ATTR-CM can lead to social isolation and depression. Prioritize staying connected with loved ones through phone calls, visits, or social activities. Joining a support group can provide a safe space to share experiences and reduce feelings of loneliness.
Given the disease’s prognosis, discuss “goals of care” with your family and healthcare team. Some may prefer symptom relief, while others prioritize extending life. Complete an advanced directive and designate a durable power of attorney for medical decisions in case you become unable to speak for yourself.
The bottom line: ATTR-CM requires a proactive, multidisciplinary approach. Early diagnosis, symptom management, and careful consideration of quality-of-life preferences are essential for maximizing well-being in older adults.
