Signs You Need to Know About
When most people think of a heart attack, they imagine sudden chest pain, clutching the chest, and an emergency room visit. While these dramatic symptoms do occur, not all heart attacks present the same way—especially when they're linked to a lesser-known condition called transthyretin amyloid cardiomyopathy (ATTR-CM). Often underdiagnosed and misinterpreted as typical heart failure, ATTR-CM can quietly lead to severe cardiac events, including heart attacks. Knowing the unique warning signs of a heart attack can be life-saving, particularly for older Americans.
Common Warning Signs of a Heart Attack Due to ATTR-CM
Heart attacks related to ATTR-CM may not always resemble the classic symptoms we're used to hearing about. Here are the most common—and often overlooked—warning signs:
1. Unexplained Fatigue or Shortness of Breath
One of the earliest signs is often a persistent feeling of fatigue, even with minimal activity. Climbing stairs or walking short distances may suddenly feel exhausting. This can be due to the heart's reduced ability to pump efficiently as amyloid builds up in the heart muscle.
2. Swelling in the Legs, Ankles, or Abdomen
Fluid retention, especially in the lower limbs or belly, can indicate that the heart isn’t pumping properly. In ATTR-CM, the stiffened heart walls can't relax normally, leading to congestive symptoms.
3. Irregular Heartbeat or Palpitations
Many patients with ATTR-CM experience arrhythmias, or irregular heartbeats. These may feel like fluttering, a racing heart or skipped beats. Some people may faint or feel dizzy due to these disruptions in rhythm.
4. Chest Discomfort
While chest pain is a hallmark sign of a heart attack, in ATTR-CM, it may present as a more subtle pressure or tightness rather than sharp pain. It might come and go, and can be mistaken for indigestion or muscle strain.
5. Numbness or Tingling in Hands and Feet
ATTR-CM can be systemic, meaning it affects more than just the heart. Nerve involvement may cause symptoms like tingling, burning or numbness, often misdiagnosed as carpal tunnel syndrome—especially if it occurs in both wrists.
6. Unintended Weight Loss or Gastrointestinal Issues
Some individuals with ATTR-CM report unexplained weight loss or digestive problems such as nausea, constipation or early satiety (feeling full quickly). These may be signs that amyloid deposits are affecting organs beyond the heart.
7. History of Bilateral Carpal Tunnel Syndrome or Spinal Stenosis
If you've had surgeries or long-term symptoms related to carpal tunnel or narrowing of the spinal canal, and you now have heart-related symptoms, it may be a red flag. These orthopedic conditions often precede a diagnosis of ATTR-CM by several years.
When to Seek Medical Help
If you or a loved one experience any combination of the symptoms above—especially if you're over 60, have heart failure that’s not improving with standard treatment or have a family history of heart disease—talk to your doctor. A simple blood test or cardiac imaging may prompt further evaluation for ATTR-CM. Early diagnosis can significantly improve outcomes.
Treatment Options for ATTR-CM
Fortunately, treatments for ATTR-CM have advanced in recent years. While there is no cure yet, several options can slow disease progression and manage symptoms:
- Tafamidis (Vyndaqel®). FDA-approved to stabilize the TTR protein and prevent amyloid buildup in patients with ATTR-CM.
- Patisiran and Inotersen. Used for hereditary ATTR with polyneuropathy, and currently being studied for cardiac forms.
- Supportive care. Includes diuretics for fluid management, heart failure medications (with caution) and treatment of arrhythmias.
- Lifestyle adjustments. Reducing sodium intake, managing blood pressure and staying active within limits can all help.
In severe cases, heart transplantation may be considered, although this is less common due to the systemic nature of the disease.
The Bottom Line
Heart attacks tied to ATTR-CM can present differently than typical cardiac events. For Americans—especially older adults and those with unexplained heart failure symptoms—it’s important to be aware of the subtle signs. If diagnosed early, ATTR-CM can be managed, allowing patients to maintain quality of life and avoid catastrophic events. Always listen to your body and advocate for answers when something doesn’t feel right.
Keep reading for tips on maintaining a heart-healthy diet.