**7. Treatment options**

Management of cardiac amyloidosis consists of treatment and management to stabilize heart failure symptoms while providing medications to stabilize amyloidogenic protein (**Figures 7** and **8** and **Table 2**). An interdisciplinary treatment approach is paramount in lieu of patients' limited physical capacity and quality of life due to the extensive extracardiac symptom involvement. Diuretics tend to be the first line of management for the control of congestive symptoms. These may be prescribed in combination with mineralocorticoid receptor antagonists. Usually, these patients have higher rate of third spacing with associated right heart failure, thus frequently require diuretics with better bioavailability such as bumetanide and torsemide and addition of mineralocorticoid agents. One of the main challenges patients with CA face is recurrent congestion requiring high dose of diuretics as well as frequent hospitalization. However not all traditional drugs used for the treatment of HF are adequate or have been proven to exert any benefit in patients with cardiac amyloidosis.

On the other hand, neurohormonal antagonists which are typically used in HF treatment are often poorly tolerated and might be counterproductive in some patients.


*ATTR, transthyretin amyloidosis; wtATTR, wild type-transthyretin amyloidosis; h or v ATTR, hereditary or variant type-transthyretin amyloidosis; eGFR, estimated glomerular filtration rate; N-Pro-BNP, N-terminal-pro hormone-brain natriuretic peptide; NYHA, New York Heart Association; dFLC, lambda to kappa free light chain ratio difference.*
