47⬅ Donald Trump: Systemic Amyloidosis

Introduction

The three suspicion-arousing data points listed above are simple and clear. So why is this website so extensive? What more needs to be said?

Well, some readers will rightly be skeptical and will make counter-points such as:

• "We know what the leg swelling is — it's just bad leg veins." MORE

• "We know what the bruising is — it's just aspirin and handshaking." MORE

• "There's not enough evidence to diagnose amyloidosis."
  (True! But my point is just that Trump needs testing for it.)

• "The man is 80 years old, so of course he doesn't look like he used to."

• "Some dude is medically picking on Trump."
  (No, I do this with every president.)

All of these lead up to the hyper-skeptic's wishful but inaccurate bottom line:

• "There's just no reason to test Trump for amyloidosis."

It takes verbiage to put these and other points to rest.

It also takes verbiage to communicate the additional features of Trump's medical status, such as his bruising, anemia, etc. Strictly speaking, this material does not prominently factor into the need to test for amyloidosis, but it does illustrate the pervasiveness of whatever is afflicting Trump and it shows what appears to be deliberate concealment of medical information that is material to the conduct of a presidency.

Finally, if amyloidosis is ruled out by the definitive tests, then the clinical material collected here may assist others in identifying a cause for President Trump's ailments.

Asides appear like this.

When to suspect: abridged version — "clues""

It helps to rework the three observations listed above into two broader statements:

• Trump's low blood pressure and generalized fluid retention point to heart failure;
• Amyloidosis is the most likely cause of his heart failure because he has no history of hypertension, plus his echo shows good cardiac squeeze, plus his parents lived long.

Now we can look in medical journals and see whether experts agree with the significance of these factors.

We start with this expert advice:

A number of important clinical clues to the presence of [cardiac amyloidosis] have been described. One clue is a "natural cure" of hypertension: the need for down-titration or discontinuation of antihypertensive therapy. 3

This expert "clue" is equivalent to our observation that Trump's blood pressure has recently dropped. Trump never had hypertension, but almost everyone in the amyloidosis age bracket does, so the essential point is that the patient's blood pressure is now lower than it has been... and Trump fits that.

This is a powerful clue, because hypertension does not naturally cure itself. In other words, it is very unusual to see someone's blood pressure drop without some externally visible cause, such as weight loss, diet change, pill-taking, exercise, etc.

Next:

The signs and symptoms that should raise suspicion of [cardiac amyloidosis] include a history of right-sided heart failure; heart failure with preserved ejection fraction (especially in men); ... 4

Trump fits this recommendation, too. The mention of "right-sided heart failure" refers to cases of heart failure where swelling of the limbs is prominent... as it is in Trump. The mention of heart failure with "preserved ejection fraction" means a failing heart that squeezes well... as it does in Trump.

Thus, these two expert recommendations, alone, support a suspicion of amyloidosis in Donald Trump. The other two positive statements about him — no past hypertension, plus long-lived parents — ironically turn negative because they further strengthen the suspicion of amyloidosis, as we'll see below.

More simply, if your 80-year-old father had these findings, you'd want him tested for amyloidosis. There is not one sign that President Trump has been tested for amyloidosis.

When to suspect: unabridged version — "understanding"

In the name of transparency, I admit that I arrived at the amyloidosis suspicion in President Trump not with the clues above, but with the combination of marked non-traumatic bruising and marked ankle swelling, which I remembered seeing for years in an amyloidosis patient.

The possibility seemed incredible, so the next step was to look at the rest of Trump's clinical picture and see how that fit with the amyloidosis hypothesis. I was looking for an understanding of his physiology, to explain all of the other findings that review of his medical reports exposed.

As part of this search, I was also looking for some fact that would veto the amyloidosis suspicion, but, as the rest of this website demonstrates, found none.

So, below, I present my current understanding, diagrammed as a path of five steps like "If A and B, then C." It starts with simple observations, then concludes with a strong suspicion that Trump has cardiac amyloidosis, which equates to systemic amyloidosis.

Just as importantly, the path shows how many times the president's physician could have demolished the amyloidosis suspicion, but omitted the test results that could do so.

After presenting the path, the page briefly notes that amyloidosis explains some non-cardiac observations about Trump, then engages in speculations about other possible manifestations.

Step 1

The first step is removing the idea that Trump's swollen legs are due to bad veins in the legs, which is medically called "chronic venous insufficiency."

This is easily done by noticing that his face is also swollen. But even if the facial swelling is disputed, there are other solid reasons to discard the presidential physician's diagnosis of chronic venous insufficiency. MORE

An important possibility, not shown in the diagram, is that Trump might have amyloidosis in his kidneys, causing "nephrotic syndrome," i.e. the spilling of protein into the urine. Nephrotic syndrome causes marked fluid retention, not just in the legs, but especially in the face, too.

The important overall conclusion is that the diagnosis of chronic venous insufficiency does not fully account for Trump's fluid retention.

Step 2

The next step is removing the idea that Trump has "no signs of heart failure" as the presidential physician said in July 2025, but never since then. Of course, the physician was wrong when he said that, because swollen legs are a sign of heart failure. Yes, an overly-picky style fault. Still.

But the presidential physician's claim is untenable for 10 other reasons, each discussed at length on another page. MORE

The diagram shows that a combination of three findings — a low blood pressure, fluid retention that is not due to disease in the leg veins, and daytime sleepiness all add together to produce a suspicion of heart disease (at bottom).

The daytime sleepiness is not that important. As discussed at the top of this page, the blood pressure is extremely important, especially when teamed with the leg swelling. The reasons for this are discussed elsewhere and specifically note that a systolic blood pressure of 105 may be wonderful in most of the population, but it is concerning in an overweight, sedentary, salt-guzzling, fluid-retaining elderly man whose previous blood pressures were significantly higher. MORE

The seven orange rectangles in this diagram tell an important additional story. They represent seven pieces of clinical data that could have been used to demolish or weaken the idea that Trump has heart failure. For example, if Trump's blood pressure dropped even more when he stood up ("orthostatics") that could simply mean that he was dehydrated, and so a systolic blood pressure of 105 would not count as evidence of heart failure.

Actually, however, orthostatic blood pressure drops can occur when amyloidosis involves autonomic nerves, even to the point of causing the patient to be confused 4. So take the orthostatic diagnostic comment as only a poor example.

But the presidential physician reported none of those seven data elements in any of his reports (in July, October, December 2025 and May 2026). A cynic might say it was because he knows that Trump has heart failure, and supplying those missing elements would do nothing but make heart failure more obvious to the public.

Step 3

This step is simple. In most cases of heart failure the heart is squeezing weakly, and that makes intuitive sense. But there is another type of heart failure, called HFpEF (pronounced "heff-peff"), in which the heart squeezes normally but does not relax normally.

A cardiac ultrasound test tells the physician which type of heart failure is at work. In Trump's case, the ultrasound ("echocardiogram") was said to show that his heart squeezes normally. Thus, Trump has the HFpEF type of heart failure.

Step 4

Once a physician knows (or suspects) that the patient has the HFpEF type of heart failure, the next step is to identify the particular disease that is causing it. HFpEF is not itself a disease. It is a finding with several possible causes.

By far, the most common cause of HFpEF is hypertension (high blood pressure). Trump has never had high blood pressure, so we have to look for other causes.

Some genetic diseases, like hemochromatosis and Fabry disease, can cause HFpEF, but Trump's family history is benign, and it would be unlikely for them to strike this late in life.

That leaves two possible causes: amyloidosis and sarcoidosis. Sarcoidosis is a multisystem disease that especially targets the lungs. A normal chest x-ray and a normal "ACE" level in the blood would help rule out sarcoidosis, but those results were not reported.

Good evidence against sarcoidosis is available, however: sarcoidosis responds to treatment. If Trump had sarcoidosis and his doctors knew it and they treated him, his heart failure would get better and his ankle swelling would get better. That didn't happen.

We can therefore conclude that Trump does not have sarcoidosis, which leaves cardiac amyloidosis as the only remaining possible cause for HFpEF. It fits also in the sense that heart failure due to cardiac amyloidosis is difficult to treat.

Step 5

Any patient diagnosed with cardiac amyloidosis is automatically diagnosed with systemic amyloidosis. Amyloidosis sometimes occurs in the skin only, but it does not occur in the heart only. If it's in the heart, it is going to be everywhere.

Summary of all steps

In case you want to see all five steps at once, they are here:

Abbreviations:
· ACE = angiotensin converting enzyme
· BP = blood pressure
· EKG = electrocardiogram
· HFpEF = heart failure with preserved ejection fraction
· LV = left ventricle
· MSLT = multiple sleep latency test
· PA = pulmonary artery
· PYP = pyrophosphate
· RA = right atrium
· r/o = rule out

Trump's amyloidosis outside the heart

Amyloidosis explains observations about Trump outside of his heart. This is why it's called "systemic amyloidosis."

• His chronic bruising MORE

  Bruising is a hallmark of systemic amyloidosis, caused by amyloid proteins infiltrating the walls of small blood vessels. This makes them stiff and fragile, prone to breakage and bleeding with minor trauma — or sometimes no trauma at all.

  Trump has noticed this, and it may be a component of his fragile skin that is susceptible to cuts MORE.

  Less often, amyloidosis patients will become prone to bleeding because of abnormalities in their blood clotting

• His chronic anemia MORE

  Patients with amyloidosis may develop anemia for a variety of reasons, and this holds true for Trump, even if he does not have amyloidosis. See the anemia page for deeper discussion.

• His chronic sleepiness MORE

  The source of this problem would be in the heart, but most people do not think of sleepiness as a heart problem, so it is listed here as "outside the heart." Poor sleep can mimic a vast array of psychological conditions.

• His healthcare utilization — 22 consultants

  Presidents see lots of physicians during their physical. Trump set a record of 22 in May 2026 MORE, compared to 14 in April 2025 MORE, and 12 in 2019 MORE (unclear if all of these were physicians). Joseph Biden saw 13 in 2021, 11 in 2023, and 11 in 2024 (never a urologist, alas).

  It does not take 22 physicians to tell someone they are well.

  I once had an astronaut physical and saw six physicians (internist, ophthalmologist, cardiologist, psychiatrist, gastroenterologist, otolaryngologist), plus a dentist and a rather cheesed-off psychologist. No doubt, a pulmonologist, nephrologist, radiologist, endocrinologist, and hematologist looked at test results behind the scenes. That makes 13, including 11 physicians.

  Part of the reason for 22 may be Trump's age. Another reason, however, may be the systemic effects of amyloidosis, which can affect most, if not all, organs in the body, each of which has a specialist attached in modern American medicine.

• His healthcare utilization — missing test results

  It is insane to realize that the most important man in the world, in the richest nation in the world, with the most advanced healthcare in the world, underwent a physical examination that did not include a urinalysis, a chest x-ray, or a standard electrocardiogram, and his doctors missed the fact that he is anemic, sleepy, and bruised all over.

  Yet, if you read Trump's 2026 medical report, that is exactly what happened.

  No one should believe it. Children going to soccer camp get a urinalysis and an EKG. All those tests and all those problems were evaluated. But something in the results is too private to be released publicly.

Speculations

Some puzzling observations about Donald Trump could make sense if they were part of an amyloidosis illness. The evidence here is limited, so these possibilities qualify only as "speculations."

• He may have a surgical scar on his right wrist resulting from carpal tunnel surgery MORE

• His tentative gait, especially going down stairs, could be due to amyloid peripheral neuropathy in his feet. At the other extreme of concern, it could be due to precariously fitted elevator shoes!

• His mystery test indications

  Trump underwent CT angiograms of the coronary and pulmonary arteries in 2025, and almost underwent a cardiac MRI. No specific reasons were given for this testing, but it is reasonable to believe that these tests were seeking to understand why he was having heart failure.

  I expect the physicians suspected amyloidosis before they began this search, but felt they had to pursue the possibility that a second problem could be afflicting Trump. Finding a second problem would be good news if it were treatable, because eliminating its contribution to Trump's decay would improve his medical state. Rejecting the cardiac MRI in this setting makes sense, because there is no point in confirming a poorly treatable disease, and it would have tipped off every cardiologist in the country that heart muscle disease was being considered as a possibility.

• As noted, amyloidosis can have psychological effects due to sleepiness and fatigue. Fatigue is different from sleepiness. It is interesting to remember Warren Harding's comment about the most prominent symptom in his own terminal heart disease: "I had no idea that a man could be so completely exhausted," and he played golf six days before he died! MORE

  Beyond that, it is simply impossible to point to a particular behavior in any amyloidosis patient and pin it on amyloidosis itself.

• Well, there is one psychological effect that can be pinned on amyloidosis: the appreciation of one's approaching mortality can change behavior. I leave it to readers to think about this.

• Radioactive zone

  I am not going to speculate on projected lifespan or on current governance.

Evasion speculations

Given what appears to be an adversarial approach to information disclosure by the presidential physician, I worry that the response to even a simple question like "What is the evidence the president does NOT have amyloidosis" could get engineered into a non-response.

It is possible. I could deflect the calls by saying "These suspicions of amyloidosis are so unfounded that they need no reply. They're unfounded because the president's most recent blood pressure was 125/75, and here is a photo of his skinny ankles, and I can report to you that his intracardiac pressures were completely normal. So you can see that the data driving the suspicion of amyloidosis was misinterpreted, and there is no reason to test the president for amyloidosis."

And they could that truthfully if:

1. They gave Trump vasoconstrictor medicines like midodrine, which raise blood pressure and are recommended when autonomic amyloidosis neuropathy is present 3;
2. Trump wore compression stockings to shrink his ankle size;
3. On a separate day, Trump underwent extremely aggressive diuresis to lower intracardiac pressures, perhaps at the cost of creating a blood pressure so low that he could not stand upright for a time, then, on top of that, had his intracardiac pressures measured while he was sitting up or tilted up, to lower them even more.

If you are a member of the press, make sure that these tricks are not pulled on you.

Of course, it is trivial to dissolve a suspicion of amyloidosis by lying and having the medical people fall on their sword. An unscrupulous person could say "In retrospect, one of President Trump's 22 consultants had started him on a medication that caused an unexpected drop in blood pressure that we noticed quickly, but not immediately. We apologize for our oversight and for the confusion it caused, and thank the public for bringing it to our attention." Or, "We erred by measuring the president's blood pressure too soon after he had been subjected to a demanding medical test." In both examples, questions would afterwards arise, but they would be questions about the doctors and nurses in the White House Medical Unit, not about the president's health — mission accomplished.

Apology: caveats on "definitive" nuclear-scan testing

Nothing in medicine is as simple as it first seems. But it is counter-productive to present the full complexity right off the bat because it only causes frustration and confusion.

If you have endured this far, however, you deserve to know some of the additional details around the supposedly "definitive" nuclear scan for amyloidosis.

The first is that the nuclear scan requires preliminary tests — a simple blood draw and urine collection — to ensure it will provide trustworthy results. MORE

The second is that the nuclear scan is known to miss some cases of cardiac amyloidosis. There was no false advertising here, because no one should expect that any test in medicine is perfect. The sleazy part is what to do after a negative scan. Experts from the American College of Cardiology advise that "further investigation is warranted if the clinical suspicion is high" 5.

In other words, if a physician is very suspicious of cardiac amyloidosis before the scan, and is surprised by a negative result from the scan, the physician should not accept the negative result without doing more work — the "further investigation."

How does that leave us with Trump? I would say the following...

If Trump's physician were to announce in one sentence that the nuclear scan was negative, then, given my current strong level of suspicion, I would say further investigation is warranted, and that Trump should have a cardiac biopsy (which is easy, safe, and painless).

But if Trump's physician were to announce a negative scan along with negative results from the many omitted tests identified throughout this website, then I would accept the accuracy of the negative nuclear scan. That is because the raft of negative results from the omitted tests would lower my level of suspicion.

Hence, the true sleaze is that my request for a simple read-out on the results from the nuclear test is really a request for more than that if the test is negative.

Summary

The master diagram on this page reinforces three main points:

• (1) A clinical suspicion of amyloidosis is well-founded for President Trump.

• (2) Given the well-founded suspicion, a technetium PYP scan is indicated to rule out amyloidosis — or to rule it in.
  • This assumes blood and urine tests for monoclonality are negative
  • It also assumes no recent tissue is available for Congo red staining

• (3) The results of the technetium scan should be publicly disclosed.

The master diagram has an important secondary purpose: to show the large amount of medical data that the White House has suppressed. I cannot be sure they have acquired all the data noted as missing, but I can be sure they have acquired most of it. Each item labelled as missing data has the potential to weaken (or strengthen) the amyloidosis suspicion, depending on its value.

Finally, let's move to human considerations.

A strict reading of Trump's most recent medical report offers no clue that the president's physician has even considered the possibility amyloidosis. If one accepts that, improbable as it may be, it becomes an ethical good to bring amyloidosis to the attention of the president and his physician so treatment can begin.

That ethical good is magnified because of the limited effect of amyloidosis treatments. They do not reverse the disease. Thus, if he has amyloidosis, every day without treatment is another day of irreversible decline. Getting the president diagnosed and onto treatment as soon as possible is therefore imperative.