Cardiac Amyloidosis: Everywhere, but Nowhere

Clinical pathways in the evaluation and management of cardiac amyloidosis (CA) are haphazard in Malaysia. Presented here are two cases that serve as examples of how diagnosis of CA can often be missed or delayed, leading to serious consequences. A complex interplay between various factors contributes to this, including lack of expertise and facilities to support early recognition and confirmation of CA affecting laboratory services, radiological services, and expertise in the disease. A lack of coordinated care involving various disciplines and subspecialties has been a barrier in establishing a national-level clinical pathway for CA. Additionally, there is poor awareness among clinicians surrounding CA, where limited experience in managing the disease is concentrated in major centres. Building an amyloidosis network may be the way forward, as the onus is on clinicians to improve the way they communicate with each other.