Absence of Heart Failure in Severe Cardiac and Autonomic Amyloidosis: The Essential Role of Sympathetic Activation and Venous Tone in the Development of the Congestive Heart Failure Syndrome

The document presented a case of a 66-year-old man with primary light-chain amyloidosis who, despite having severe cardiac involvement, did not exhibit typical symptoms of heart failure. This absence of symptoms was attributed to his severe autonomic neuropathy, which impaired sympathetic activation and venous tone, crucial for developing congestive heart failure symptoms. The case highlighted the essential role of the sympathetic nervous system in heart failure, where sympathetic activation and increased venous tone are necessary to elevate central venous pressure and trigger heart failure symptoms. The findings suggested that reducing neurohormonal activation could be a critical therapeutic goal in treating congestive heart failure.