How to Handle Fatigue With ATTR-CM

Fatigue is one of the most frustrating symptoms of transthyretin cardiac amyloidosis (ATTR-CM). It can reduce your overall quality of life, limiting your ability to complete daily tasks and participate in social events. It may even accelerate disease progression.

“Not only do your other organs suffer, but the heart itself needs to use more nutrients to achieve the same effect,” says Yu-Ming Ni, MD, a board-certified cardiologist and lipidologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “This is likely to be the main reason for fatigue.”

Fortunately, there are a number of ways to help manage this common ATTR-CM symptom.

If fatigue is interfering with your daily life, start with a visit to your healthcare provider. They can help isolate and treat other health conditions that may be contributing to your sense of fatigue, such as sleep apnea (a sleep disorder in which breathing stops and starts during the night), anemia (a shortage of healthy red blood cells to carry oxygen to the body’s tissues), and high blood pressure (hypertension).

Some medications used to treat complications of ATTR-CM may also worsen fatigue.

“People with ATTR-CM often develop abnormal heart rhythms and need beta-blockers, which slow heart rate and contribute to fatigue,” says Ajay Vallakati, MBBS, a board-certified internal medicine physician specializing in advanced heart failure at The Ohio State University Wexner Medical Center in Columbus, Ohio. Your doctor may be able to adjust your dosage or prescribe alternative medications.

Once you’ve addressed other health issues and potential medication side effects with your doctor, try managing the remaining fatigue with the “spoon theory” of energy conservation.

For people with ATTR-CM-related fatigue, this approach may help you prioritize essential activities and postpone less critical tasks. You can also plan strategic rest periods like scheduled naps to help restore your energy throughout the day.

Exercise can be challenging if you struggle with fatigue. However, even short sessions of low-impact activity like walking, gardening, and cycling offer benefits that may reduce ATTR-CM-related fatigue.

“[Exercise] helps fight deconditioning, or the loss of strength and stamina that can happen when someone is less active,” says Dr. Vallakati. It trains your heart to pump more efficiently and your muscles to make better use of available oxygen, which can help you perform daily activities with less fatigue.

“It’s also important to ensure that people with ATTR-CM stay well hydrated, as low blood pressure due to dehydration can cause fatigue,” says Vallakati. He recommends keeping water bottles within easy reach around the house.

To conserve energy, people living with ATTR-CM should consider updating their living space for maximum efficiency.

“People with ATTR-CM can make daily life easier by organizing their home to reduce physical strain,” says Vallakati. For example, keeping frequently used items within reach, incorporating mobility aids like grab bars or shower chairs, and using adaptive kitchen appliances and personal care tools can minimize exertion.

Ask a friend or family member to help install these devices and reorganize commonly used items, or find support from local caregiver services.

You don’t have to cope with ATTR-CM fatigue on your own. Lean on friends, family members, professional services, and community resources for support.

Ask loved ones for help with chores you can no longer manage independently, such as grocery shopping, lawn care, or home repairs. Also, consider attending community events and adaptive exercise classes designed to help people with physical limitations stay active and build social connections.

• Consult your doctor to rule out conditions like anemia, sleep apnea, and high blood pressure, as well as to potentially adjust certain medications that may be worsening your ATTR-CM-related fatigue.
• Conserve your energy by prioritizing daily tasks, planning strategic rest periods, and optimizing your living space to minimize physical exertion.
• Focus on getting high-quality sleep and consistent moderate-intensity exercise to help minimize sleep disruptions common in ATTR-CM and improve overall heart efficiency and stamina.
• Maintain stable energy levels by staying well hydrated, eating balanced meals, and being mindful of your sodium intake to prevent fluid buildup.