pyrophosphate cardiac scan (2023)

Myocardial Infarct Scan

Synonym/acronym: PYP cardiac scan, infarct scan, pyrophosphate cardiac scan, acute myocardial infarction scan.

Common use

To differentiate between new and old myocardial infarcts and evaluate myocardial perfusion.

(Video) 99mTechnetium Pyrophosphate Imaging for Diagnosis of Transthyretin Cardiac Amyloidosis

Area of application

Heart, chest/thorax.


IV radioactive material, usually technetium-99m stannous pyrophosphate (PYP).

(Video) Technetium Pyrophosphate Scan Benefits


Technetium-99m stannous pyrophosphate (PYP) scanning, also known as myocardial infarct imaging, reveals the presence of myocardial perfusion and the extent of myocardial infarction (MI). This procedure can distinguish new from old infarcts when a patient has had abnormal electrocardiograms (ECGs) and cardiac enzymes have returned to normal. PYP uptake by acutely infarcted tissue may be related to the influx of calcium through damaged cell membranes, which accompanies myocardial necrosis; that is, the radionuclide may be binding to calcium phosphates or to hydroxyapatite. The PYP in these damaged cells can be viewed as spots of increased radionuclide uptake that appear in 12 hr at the earliest.

(Video) Cardiac Amyloidosis: What is Amyloidosis?

PYP uptake usually takes place 24 to 72 hr after MI, and the radionuclide remains detectable for approximately 10 to 14 days after the MI. PYP uptake is proportional to the blood flow to the affected area; with large areas of necrosis, PYP uptake may be maximal around the periphery of a necrotic area, with little uptake being detectable in the poorly perfused center. Most of the PYP is concentrated in regions that have 20% to 40% of the normal blood flow.

Single-photon emission computed tomography (SPECT) can be used to visualize the heart from multiple angles and planes, enabling areas of MI to be viewed with greater accuracy and resolution. This technique removes overlying structures that may confuse interpretation of the results. With the availability of newer biomarkers such as troponin, myocardial infarct imaging has become less important in the diagnosis of acute MI.

(Video) Tc-PYP scan for A-TTR Cardiac Amyloid

This procedure is contraindicated for

  • high alert Patients who are pregnant or suspected of being pregnant, unless the potential benefits of a procedure using radiation far outweigh the risk of radiation exposure to the fetus and mother.


  • Aid in the diagnosis of (or confirm and locate) acute MI when ECG and enzyme testing do not provide a diagnosis
  • Aid in the diagnosis of perioperative MI
  • Differentiate between a new and old infarction
  • Evaluate possible reinfarction or extension of the infarct
  • Obtain baseline information about infarction before cardiac surgery

Potential diagnosis

Normal findings

  • Normal coronary blood flow and tissue perfusion, with no PYP localization in the myocardium
  • No uptake above background activity in the myocardium (Note: when PYP uptake is present, it is graded in relation to adjacent rib activity)

Abnormal findings related to

  • MI, indicated by increased PYP uptake in the myocardium

Critical findings


Interfering factors

  • Factors that may impair clear imaging

    • Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status.
    • Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images.
    • Other nuclear scans done within the previous 24 to 48 hr.
    • Conditions such as chest wall trauma, cardiac trauma, or recent cardioversion procedure.
    • Other conditions that may interfere include:
      • Aneurysms
      • Cardiac neoplasms
      • Left ventricular aneurysm
      • Metastasis
      • Myocarditis
      • Pericarditis
      • Valvular and coronary artery calcifications
  • Other considerations

    • Improper injection of the radionuclide may allow the tracer to seep deep into the muscle tissue, producing erroneous hot spots.
    • Consultation with a health-care provider (HCP) should occur before the procedure for radiation safety concerns regarding younger patients or patients who are lactating. Pediatric & Geriatric Imaging Children and geriatric patients are at risk for receiving a higher radiation dose than necessary if settings are not adjusted for their small size. Pediatric Imaging Information on the Image Gently Campaign can be found at the Alliance for Radiation Safety in Pediatric Imaging (
    • Risks associated with radiation overexposure can result from frequent x-ray or radionuclide procedures. Personnel working in the examination area should wear badges to record their level of radiation.

Nursing Implications and Procedure


  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assess blood flow to the heart.
  • Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex, anesthetics, sedatives, or radionuclides.
  • Obtain a history of the patient’s cardiovascular system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent procedures that can interfere with test results, including examinations using iodine-based contrast medium.
  • Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Address concerns about pain related to the procedure and explain that some pain may be experienced during the test, and there may be moments of discomfort. Reassure the patient that the radionuclide poses no radioactive hazard and rarely produces side effects. Inform the patient that the procedure is performed in a nuclear medicine department by an HCP specializing in this procedure, with support staff, and will take approximately 30 to 60 min. Inform the patient that the technologist will administer an IV injection of the radionuclide and that he or she will need to return 2 to 3 hr later for the scan.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Explain that an IV line may be inserted to allow infusion of IV fluids such as normal saline, anesthetics, sedatives, radionuclides, medications used in the procedure, or emergency medications.
  • Instruct the patient to fast, restrict fluids, and refrain from smoking for 4 hr prior to the procedure. Instruct the patient to withhold medications for 24 hr before the procedure. Protocols may vary among facilities.
  • Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
  • Instruct the patient to remove jewelry and other metallic objects from the area to be examined.


  • Potential complications:
  • Although it is rare, there is the possibility of allergic reaction to the radionuclide. Have emergency equipment and medications readily available. If the patient has a history of allergic reactions to any substance or drug, administer ordered prophylactic steroids or antihistamines before the procedure.

  • Establishing an IV site and injecting radionuclides is an invasive procedure. Complications are rare but do include bleeding from the puncture site related to a bleeding disorder, or the effects of natural products and medications known to act as blood thinners; hematoma related to blood leakage into the tissue following needle insertion; infection that might occur if bacteria from the skin surface is introduced at the puncture site; or nerve injury that might occur if the needle strikes a nerve.

    (Video) Prem Soman, MD, PhD, MASNC on Tc-99m PYP Scan to Diagnose ATTR Cardiac Amyloidosis

  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
  • Ensure that the patient has complied with dietary and medication restrictions and other pretesting preparations.
  • Ensure that the patient has removed all external metallic objects prior to the procedure.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Have emergency equipment readily available.
  • Instruct the patient to void prior to the procedure and to change into the gown, robe, and foot coverings provided.
  • Record baseline vital signs and assess neurological status. Protocols may vary among facilities.
  • Establish an IV fluid line for the injection of saline, anesthetics, sedatives, radionuclides, or emergency medications.
  • Instruct the patient to cooperate fully and to follow directions. Instruct the patient to lie very still during the procedure because movement will produce unclear images.
  • Place the patient in a supine position on a flat table with foam wedges to help maintain position and immobilization.
  • IV radionuclide is administered. The heart is scanned 2 to 4 hr after injection in various positions. In most circumstances, however, SPECT is done so that the heart can be viewed from multiple angles and planes.
  • Monitor the patient for complications related to the procedure (e.g., allergic reaction, anaphylaxis, bronchospasm).
  • Remove the needle or catheter and apply a pressure dressing over the puncture site.
  • Observe/assess the needle/catheter insertion site for bleeding, inflammation, or hematoma formation.


  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Instruct the patient to resume normal activity and diet as directed by the HCP.
  • Unless contraindicated, advise the patient to drink increased amounts of fluids for 24 to 48 hr to eliminate the radionuclide from the body. Inform the patient that radionuclide is eliminated from the body within 6 to 24 hr.
  • No other radionuclide tests should be scheduled for 24 to 48 hr after this procedure.
  • Evaluate the patient’s vital signs. Monitor vital signs and neurological status every 15 min for 1 hr, then every 2 hr for 4 hr, and then as ordered by HCP. Take temperature every 4 hr for 24 hr. Monitor intake and output at least every 8 hr. Compare with baseline values. Notify the HCP if temperature is elevated. Protocols may vary among facilities.
  • Observe for delayed allergic reactions, such as rash, urticaria, tachycardia, hyperpnea, hypertension, palpitations, nausea, or vomiting.
  • Instruct the patient to immediately report symptoms such as fast heart rate, difficulty breathing, skin rash, itching, chest pain, persistent right shoulder pain, or abdominal pain. Immediately report symptoms to the appropriate HCP.
  • Instruct the patient in the care and assessment of the injection site.
  • If the patient must return for additional imaging, advise the patient to rest in the interim and restrict diet to liquids before redistribution studies.
  • If a woman who is breastfeeding must have a nuclear scan, she should not breastfeed the infant until the radionuclide has been eliminated. This could take as long as 3 days. She should be instructed to express the milk and discard it during the 3-day period to prevent cessation of milk production.
  • Instruct the patient to flush the toilet immediately after each voiding following the procedure and to meticulously wash hands with soap and water after each voiding for 24 hr after the procedure.
  • Instruct all caregivers to wear gloves when discarding urine for 24 hr after the procedure. Wash gloved hands with soap and water before removing gloves. Then wash hands after the gloves are removed.
  • Nutritional Considerations: Abnormal findings may be associated with cardiovascular disease. Nutritional therapy is recommended for the patient identified to be at risk for developing coronary artery disease (CAD) or for individuals who have specific risk factors and/or existing medical conditions (e.g., elevated LDL cholesterol levels, other lipid disorders, insulin-dependent diabetes, insulin resistance, or metabolic syndrome). Other changeable risk factors warranting patient education include strategies to encourage patients, especially those who are overweight and with high blood pressure, to safely decrease sodium intake, achieve a normal weight, ensure regular participation in moderate aerobic physical activity three to four times per week, eliminate tobacco use, and adhere to a heart-healthy diet. If triglycerides also are elevated, the patient should be advised to eliminate or reduce alcohol. The 2013 Guideline on Lifestyle Management to Reduce Cardiovascular Risk published by the American College of Cardiology (ACC) and the American Heart Association (AHA) in conjunction with the National Heart, Lung, and Blood Institute (NHLBI) recommends a “Mediterranean”-style diet rather than a low-fat diet. The new guideline emphasizes inclusion of vegetables, whole grains, fruits, low-fat dairy, nuts, legumes, and nontropical vegetable oils (e.g., olive, canola, peanut, sunflower, flaxseed) along with fish and lean poultry. A similar dietary pattern known as the Dietary Approaches to Stop Hypertension (DASH) diet makes additional recommendations for the reduction of dietary sodium. Both dietary styles emphasize a reduction in consumption of red meats, which are high in saturated fats and cholesterol, and other foods containing sugar, saturated fats, trans fats, and sodium.
  • Social and Cultural Considerations: Numerous studies point to the prevalence of excess body weight in American children and adolescents. Experts estimate that obesity is present in 25% of the population ages 6 to 11 yr. The medical, social, and emotional consequences of excess body weight are significant. Special attention should be given to instructing the child and caregiver regarding health risks and weight-control education.
  • Recognize anxiety related to test results, and be supportive of fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services. Provide contact information, if desired, for the American Heart Association ( or the NHLBI (
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be needed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include angiography abdominal, AST, BNP, blood pool imaging, chest x-ray, CT abdominal, CT thoracic, CK and isoenzymes, culture viral, echocardiography, echocardiography transesophageal, ECG, MRA, MRI chest, myocardial perfusion scan, pericardial fluid analysis, and PET heart.
  • Refer to the Cardiovascular System table at the end of the book for related tests by body system.
(Video) PYP Scan (Technetium Pyrophosphate Scintigraphy)

Handbook of Laboratory and Diagnostic Tests, © 2013 Farlex and Partners


How sensitive is pyp scan for amyloidosis? ›

Previous studies have revealed the PYP scan to be highly accurate in detection of cardiac amyloidosis, with a reported sensitivity of 99% and specificity of 86% in the absence of evidence of monoclonal gammopathy.

What is a positive PYP scan? ›

Cardiac means related to the heart. PYP stands for pyrophosphate. A cardiac PYP scan uses a radioactive form of PYP called Tc99m-PYP. Why is the scan done? This scan can be used to find out if you have a rare disease called cardiac amyloidosis (am-uh-loi-DO-sis).

What is the prognosis for amyloidosis of the heart? ›

Amyloidosis has a poor prognosis, and the median survival without treatment is only 13 months. Cardiac involvement has the worst prognosis and results in death in about 6 months after onset of congestive heart failure. Only 5% of the patients with primary amyloidosis survive beyond 10 years.

What is the ejection fraction for cardiac amyloidosis? ›

Cardiac amyloid deposition can cause heart failure (HF) with preserved ejection fraction (HFpEF). While approximately 30 proteins have been linked to cardiac amyloidosis, monoclonal immunoglobin from clonal plasma cells (AL amyloid) and transthyretin (TTR amyloid) are the most common forms.

What is the most sensitive test for amyloidosis? ›

Biopsy for Amyloidosis

A biopsy that shows amyloid deposits is the best confirmation of amyloidosis. The physician usually takes the tissue sample from abdominal fat or rectum.

What imaging is best for amyloidosis? ›

MRI thus confirms the diagnosis of cardiac amyloidosis based on the presence of a lowered circulating/subendocardial blood gradient and an increased subendocardial/subepicardial gradient.

What causes a false positive PYP scan? ›

Blood pooling, where radiotracer is present inside the ventricular cavities without myocardial uptake, is a common cause of false positive PYP planar scanning (5).

How is amyloidosis best confirmed? ›

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that amyloid proteins are present, but only a biopsy can make a definite diagnosis.

What is the Mayo risk score for amyloidosis? ›

The stage of amyloidosis is an important predictor of outcome. According to the revised Mayo Clinic staging system, patients were assigned a score of 1 for each of dFLC ≥18 mg/dL, cTnT ≥0.025 ng/mL, and NT-proBNP ≥1,800 pg/mL, creating stages I–IV with scores of 0–3 points.

Can you live for 20 years with amyloidosis? ›

Your specific prognosis will vary depending on many factors, including how well the interventions to treat the condition work. But in general, those who have cardiac amyloidosis often now live for years after diagnosis.

What is the average age for cardiac amyloidosis? ›

The normal transthyretin protein is less prone to forming amyloid deposits than the mutated form. As a result, patients only develop the disease in older age, usually at 65 years of age or older.

Has anyone survived amyloidosis? ›

Long-term survivors are increasingly seen in AL amyloidosis and present distinct patient, organ and clonal disease features.

What is a fatal ejection fraction? ›

What do ejection fraction numbers mean? 55 to 70% – Normal heart function. 40 to 55% – Below normal heart function. Can indicate previous heart damage from heart attack or cardiomyopathy. Higher than 75% – Can indicate a heart condition like hypertrophic cardiomyopathy, a common cause of sudden cardiac arrest.

What ejection fraction can you live with? ›

An Ejection Fraction above 50% indicates that your heart is pumping normally and is able to deliver an adequate supply of blood to your body and brain. An Ejection Fraction that falls below 50% could indicate that the heart is no longer pumping efficiently and is not able to meet the body's needs.

Is 50% ejection fraction heart failure? ›

According to the American Heart Association: A left ventricle (LV) ejection fraction of about 50% to 70% is categorized as normal. A mildly reduced LV ejection fraction is usually between 41% and 49%. A reduced LV ejection fraction is usually 40% or less.

What diseases mimic amyloidosis? ›

  • Alcoholism.
  • Alzheimer's Disease.
  • Amenorrhea.
  • Anorexia Nervosa.
  • Bulimia Nervosa.
  • Chronic Obstructive Pulmonary Disease.
  • Cirrhosis.
  • Colorectal Cancer.

What is the gold standard test for amyloidosis? ›

Recently, mass spectrometry-based proteomic analysis of amyloid deposits has been shown to identify the amyloid subtype with a high degree of confidence [3, 4], and is considered the gold standard.

What can be mistaken for amyloidosis? ›

Patients are often misdiagnosed with irritable bowel syndrome (IBS), unexplained malabsorption syndrome, protein-losing enteropathy secondary to ischemia, celiac disease, or infection. Absence of abdominal pain with a diagnosis of IBS may indicate amyloidosis (Table 2).

What is the marker of amyloidosis? ›

Serum N-terminal pro-brain natriuretic peptide is a sensitive marker of myocardial dysfunction in AL amyloidosis.

How hard is it to diagnose amyloidosis? ›

Amyloidosis can be difficult to diagnose. There is no specific blood test and results of investigations vary greatly from patient to patient. The diagnosis of amyloidosis starts when a doctor becomes suspicious of the patient's symptoms. A definitive diagnosis of amyloidosis can only be made through a biopsy.

Why is amyloidosis hard to diagnose? ›

Amyloidosis is often overlooked because the signs and symptoms can mimic those of more-common diseases. Early diagnosis can help prevent further organ damage. Precise diagnosis is important because treatment varies greatly, depending on your specific condition.

Can cardiac amyloidosis be misdiagnosed? ›

Amyloidosis and Misdiagnosis

The disease can be misdiagnosed for another illness like hypertrophic cardiomyopathy, a disease in which the heart muscle becomes thickened (hypertrophied), or hypertensive heart disease.

Does amyloidosis show on ultrasound? ›

Systemic AL amyloidosis is one of the differential diagnosis of chronic musculoskeletal disease, especially when swollen and painful joints is associated with claw hands. Ultrasound evaluation is a good diagnosis tool, showing a characteristic joint and tendon involvement and assisting in guided biopsy procedure.

What is the earliest symptom in amyloidosis? ›

Signs and symptoms of amyloidosis may include: Severe fatigue and weakness. Shortness of breath. Numbness, tingling, or pain in the hands or feet.

When should you suspect cardiac amyloidosis? ›

Fatigue, shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, exercise intolerance, and peripheral edema are the presenting symptoms of cardiac amyloidosis and can also be seen in heart failure caused by other, more prevalent, etiologies, such as ischemic cardiomyopathy and aortic stenosis.

How long can you have amyloidosis before diagnosis? ›

A published survey showed a significant delay in the diagnosis of amyloidosis, with a median time to diagnosis of 7 months. 37% of participants reported a delay in the diagnosis of over a year since symptoms started and over 10% were diagnosed more than 3 years after presentation.

How rare is cardiac amyloidosis? ›

Cardiac amyloidosis is quite rare and produces symptoms very similar to other heart diseases. It is, therefore, often misdiagnosed. The disease is more common in men than in women and is rarely seen in people under age 40.

Is cardiac amyloidosis terminal? ›

In the past, cardiac amyloidosis was thought to be an untreatable and rapidly fatal disease. However, the field is changing rapidly. Different types of amyloidosis can affect the heart in different ways. Some types are more severe than others.

How long is the life span of cardiac amyloidosis? ›

Average life expectancy varies based on the type of cardiac amyloid (protein), how much the organs are involved and the stage at diagnosis. Based on these factors, the worst case scenario could be six months, while in some cases, life expectancy can be eight to 10 years after diagnosis.

What foods should I avoid with amyloidosis? ›

Avoid processed meals, salt shakers, spice blends, and soup bases that contain salt. 2. Limit Your Sugar Intake: Limit added sugar to 10% of your daily calorie intake and be wary of beverages such as soda, coffee with added syrups, and sugary juices.

What is the most common cause of death in amyloidosis? ›

Heart complications are the most common cause of death in patients with amyloidosis. The degree to which amyloidosis affects the heart is important in determining your prognosis. These amyloid deposits are in the kidneys.

Does amyloidosis ever go into remission? ›

There is no cure for patients with AL amyloidosis but more frequently patients can go into remission with drug therapy. In our experience, the majority of patients surviving the first six months can often start recovering thereafter and can typically live normal or near normal lives for years to come.

How quickly does amyloidosis progress? ›

How long that takes depends on the patient and the affected organ. Typically, 12 to 18 months will pass before amyloid buildup in the heart becomes fatal, while a patient with an affected kidney could live for 5 to 10 years, according to Gertz.

What is the new treatment for amyloidosis in the heart? ›

On May 3, the U.S. Food and Drug Administration approved Vyndaqel (tafamidis meglumine) and Vyndamax (tafamidis) capsules for the treatment of the heart disease (cardiomyopathy) caused by transthyretin mediated amyloidosis (ATTR-CM) in adults. These are the first FDA-approved treatments for ATTR-CM.

What are the odds of getting amyloidosis? ›

It can be extremely difficult to diagnose. AL amyloidosis is rare—Dr. Weiss notes that it appears in roughly a dozen people out of every million in the United States.

Is amyloidosis always terminal? ›

There's no cure for amyloidosis and severe amyloidosis can lead to life-threatening organ failure. But treatments can help you manage your symptoms and limit the production of amyloid protein. Diagnosis as early as possible can help prevent further organ damage caused by the protein buildup.

What is the longest survival for amyloidosis? ›

Abstract. The median survival in primary systemic (AL) amyloidosis is less than 18 months. No published series of patients with AL amyloidosis have reported survival of more than 10 years.

What are the symptoms of amyloidosis at the end of life? ›

However, similarly to patients with cancer, symptoms may be because of the disease process or the treatment, and can include fatigue, weakness, dyspnea, pain, dizziness, anorexia, cachexia, edema, diarrhea, and constipation.

What is a good ejection fraction for a 70 year old? ›

A normal ejection fraction of 55 to 65% is considered a sign of a healthy heart. People with an ejection fraction lower than 50% might be suffering from systolic heart failure. This is also termed Heart Failure with reduced ejection fraction.

How long can you live with an ejection fraction of 30%? ›

With this model, patients whose only risk factor was EF ≤30% had a 2-year total mortality risk of only 6.2% and a 2-year risk for arrhythmic death or cardiac arrest of only 3.5%.

Can you live with 20% ejection fraction? ›

Conclusion: Three year survival is low when ejection fraction is very low. However, once the ejection fraction is < or =20% ejection fraction is no longer a predictor of mortality.

Can your ejection fraction get better? ›

The good news: Yes, you can improve your ejection fraction. Plus, there are many benefits of doing so. Treating heart failure can help improve your heart's function and get more blood flow around the body. As a result, this may reduce your heart failure symptoms, including shortness of breath and fatigue.

What drugs improve ejection fraction? ›

The mainstay of medical treatment for patients with heart failure with reduced ejection fraction (HFrEF) are beta blockers (BB), angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA).

Will a stent help ejection fraction? ›

Reduced ejection fraction (EF) has previously been shown to be a risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). However, with the advent of stents, procedural complications and restenosis rates have reduced dramatically.

How accurate is echocardiogram for ejection fraction? ›

In 88% of studies, LVEFs obtained by angiography were >40% (479 of 542). Echocardiography also identified LVEF of >40% in the majority of studies (157 of 202, 77%). Angiographic LVEF <40% was seen in 36 of 202 (18%) studies. Echocardiography accurately detected LVEF <40% in 27 of these 36 (75%) studies.

What is the cutoff for heart failure ejection fraction? ›

A normal ejection fraction is more than 55%. This means that 55% of the total blood in the left ventricle is pumped out with each heartbeat. Heart failure with reduced ejection fraction happens when the muscle of the left ventricle is not pumping as well as normal. The ejection fraction is 40% or less.

What ejection fraction is not compatible with life? ›

39% or less is heart failure with reduced ejection fraction (HFrEF): Pumping ability is below normal. The lower the ejection fraction, the higher the risk of life-threatening complications, like cardiac arrest. Symptoms may be severe and may affect you even when sitting still.

What is the best diagnostic test for amyloidosis? ›

A biopsy is the only sure way for the doctor to diagnose amyloidosis. Imaging tests may be used to find out whether organs, such as the heart or kidneys, are affected.

What is the gold standard for diagnosis amyloidosis? ›

Since then Congo red staining and apple-green birefringence became the gold standard for establishing the amyloid diagnosis.

How sensitive is abdominal fat pad biopsy for amyloidosis? ›

Abdominal fat aspiration at an experienced center, using a 19-gauge needle, has a sensitivity of 70%–80%, and only 13% of patients with amyloidosis will not have evidence of amyloid deposition on either abdominal fat aspiration or bone marrow biopsy.

What protein indicates amyloidosis? ›

It most commonly happens when a protein made by your liver is abnormal. This protein is called transthyretin (TTR).

How is early amyloidosis diagnosed? ›

To see if you have amyloidosis, your doctor will likely order tests. A urine test and a blood test may be followed by one or more imaging procedures to take a look at your body's internal organs, such as an echocardiogram , nuclear heart test or liver ultrasound .

What blood tests are abnormal with amyloidosis? ›

Tests for abnormal antibody (immunoglobulin) proteins in the blood include the Freelite® (Serum Free Light Chain) Assay Test (also known as FLC test). A blood lab measurement of the light chains can be very helpful in initial diagnostic testing and continuous monitoring of the disease.

Do you always lose weight with amyloidosis? ›

Amyloidosis can cause unintentional weight loss. You may lose a significant amount of weight in a short amount of time. Swallowing difficulties and an enlarged tongue from amyloidosis can make eating uncomfortable, so you might be eating less than you intend to.

What are the gastrointestinal symptoms of amyloidosis? ›

Gastrointestinal (GI) symptoms: Amyloidosis in the GI tract can impact digestion interfering with the intestines and movement of food after eating. Symptoms can include less appetite, diarrhea, nausea, stomach pain, and weight loss.

What does amyloidosis pain feel like? ›

Numbness, tingling, weakness or pain in your hands or feet. If amyloid proteins collect in and put pressure on the nerves to your fingers, you may have pain and other symptoms in your wrists (carpal tunnel syndrome).


1. Prem Soman, MD, PhD, MASNC on Tc-99m PYP Scan to Diagnose ATTR Cardiac Amyloidosis
(American Society of Nuclear Cardiology (ASNC))
2. Technetium Pyrophosphate Scan Prior to TAVR
(Neurology Live)
3. Cardiac Amyloidosis: Tc-99m PYP Imaging - How to Do It Right
(American Society of Nuclear Cardiology (ASNC))
4. How to process Tc-99m PYP images for ATTR-CM: A hands-on presentation
(American Society of Nuclear Cardiology (ASNC))
5. Treatment Update: Medications for Cardiac Amyloidosis
(Mayo Clinic)
6. Cardiac amyloidosis: Role of quantitative evaluation in nuclear imaging
(Cardiac Imaging Agorà)


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