What can you expect during a pyrophosphate (PYP) scan for amyloidosis? A cardiac PYP scan is a noninvasive test that helps doctors diagnose cardiac amyloidosis. In cardiac amyloidosis, abnormal proteins called amyloid build up in the heart.

If you’ve been referred for this test, it’s natural to have questions about the process. Here’s what you need to know to prepare and to understand how this scan can help diagnose amyloidosis.

What Is Cardiac Amyloidosis?

There are different types of cardiac amyloidosis. Each has its own cause.

Transthyretin Amyloid Cardiomyopathy

Transthyretin amyloid cardiomyopathy (ATTR-CM) is caused by a protein called transthyretin (TTR). This protein becomes misshapen and collects in the heart. There are two forms of ATTR-CM — hereditary ATTR-CM and wild-type ATTR-CM, which is not inherited.

Amyloid Light-Chain Amyloidosis

Amyloid light-chain amyloidosis (AL amyloidosis) is caused by abnormal proteins called light chains, which are made by plasma cells in the bone marrow. These light chains misfold and collect in the heart and other organs. AL amyloidosis is often linked to bone marrow conditions like multiple myeloma.

What Are the Symptoms of Cardiac Amyloidosis?

Regardless of the type of cardiac amyloidosis, the buildup of amyloid proteins causes the heart walls to become stiff, making it difficult to pump blood effectively. This can lead to serious problems, including heart failure.

There are many possible symptoms of cardiac amyloidosis that can affect you from head to toe. Some examples include:

• Fatigue (tiredness that does not improve with rest)
• Shortness of breath
• Swelling from fluid buildup in the legs and ankles, or even the tongue
• Carpal tunnel syndrome
• Liver swelling
• Kidney inflammation and other problems
• Neuropathy (numbness or tingling) in your limbs

The Purpose of a PYP Scan

During a cardiac PYP scan, doctors use a special form of pyrophosphate called Tc99m-PYP. This substance contains a tiny amount of radioactive material called technetium, which helps doctors see if there are any amyloid deposits in your heart.

A PYP scan is not the only test used to help diagnose cardiac amyloidosis. Tests like echocardiography provide images of the heart’s structure and function. A cardiac MRI scan offers detailed views of the heart’s tissues, and a biopsy is still the main test doctors use to confirm the diagnosis when needed.

Here’s why the PYP scan is done:

• Diagnosis — The scan helps doctors see if you have amyloid deposits in your heart. This information can confirm if you have cardiac amyloidosis and allow you to begin treatment.
• Amyloid subtype identification — The scan helps distinguish ATTR-CM from AL amyloidosis.
• Severity assessment — The PYP scan shows how much amyloid has built up in your heart. This helps doctors understand how serious your condition is, which helps guide your treatment plan.
• Treatment monitoring — The scan can also be used to see if treatment is working. By comparing the amount of amyloid before and after treatment, doctors can check your progress.

What To Expect During a Cardiac PYP Scan

If you’ve been scheduled for a cardiac PYP scan, it’s normal to have questions about the process. Here’s what you can expect from start to finish.

How Does the Procedure Work?

The procedure begins with a small amount of Tc99m-PYP (a radioactive substance) being injected into a vein in your arm. This is called an intravenous (IV) injection. The amount of radiation is minimal and considered safe.

As the Tc99m-PYP moves through your body, it collects in areas where amyloid proteins have built up in the heart. After a short waiting period, it will be time for the scan. You’ll lie on your back on a table that slides into the scanner. During the test, a SPECT-CT scan will be done, which combines two types of images:

• Single photon emission computed tomography (SPECT) — This shows where the tracer has gathered in your heart.
• Computed tomography (CT) — This creates clear, detailed images of your heart’s structures.

Together, these pictures give your doctor a 3D view of your heart, helping them diagnose and track your condition.

The whole process of a PYP scan usually takes about 1.5 to 2 hours. This includes getting ready, the injection, and the imaging. You may spend about 30 minutes inside the scanning device. The procedure is usually quiet and not as loud as an MRI.

What Happens After the Scan?

After the scan is done, you can go back to your normal activities right away. Most of the tracer will leave your body through your urine or stool, and the rest will fade away over time naturally.

A special doctor, called a nuclear medicine doctor, will look at the images from your scan and write a report. This report will then be shared with your healthcare team, including your cardiologist (heart specialist). Your healthcare team will review the results. They will explain what the images show and what they mean for your health.

The PYP scan might not be the only test you need. Based on the results, your doctor may suggest other tests:

• An endomyocardial biopsy — Checks a small piece of heart tissue for amyloid deposits
• Amyloid fibril typing — Helps determine the type of amyloid protein in your heart
• Serum free light-chain assay — Looks for unusual proteins in your blood to check for AL amyloidosis and help tell it apart from ATTR-CM

How Can You Prepare?

If you’re pregnant or breastfeeding, or suspect you might be pregnant, let the scheduling team know in advance. Tell your doctor if you’re taking any medications or supplements.

It’s important to inform your healthcare provider if you feel uncomfortable in small or enclosed spaces (claustrophobia). The PYP scan requires you to lie still in a small, enclosed scanner, which can be tough if you feel anxious in tight spaces.

Staying calm and still is important because moving around can blur the images. Blurry images might make it harder for doctors to diagnose your condition accurately.

If needed, your doctor may recommend a mild sedative (such as lorazepam or diazepam) to help you relax during the scan. Be sure to bring the sedative with you on the day of the procedure. The technologist will let you know when to take it.

Join the Conversation

On MyAmyloidosisTeam, people share their experiences with amyloidosis, get advice, and find support from others who understand.

Are you living with cardiac amyloidosis? What has been your experience with getting a PYP scan or other diagnostic tests? Let others know in the comments below.