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Internal Medicine

Restrictive cardiomyopathy (RCM)

Cover image: Restrictive cardiomyopathy results from fibrosis or infiltrative disease of the myocardium, with the most frequent cause being amyloidosis | Medcomic/Jorge Muniz

Introduction

Restrictive cardiomyopathy (RCM) is a form of cardiomyopathy in which the walls are rigid, and the heart is restricted from stretching and filling with blood properly.

  • Diastolic dysfunction
  • L/C cardiomyopathy

Aetiology

  • PRIMARY
    1. Löffler’s endocarditis
      • Eosinophils in the heart
    2. Endocardial fibroelastosis (children)
      • Fibrosis of endocardium + subendocardium
  • SECONDARY
    • Infiltitative:
      1. Cardiac amyloidosis
        • Familial amyloid cardiomyopathy
          • TTR (transthyretin) mutation
        • Senile cardiac amyloidosis (elderly)
          • Wild-type TTR deposition in heart
      2. Sarcoidosis
        • Granulomas
      3. Hemochromatosis
    • Interstitial:
      • Radiation → reactive oxygen species → Fibrosis

Pathophysiology

restrictive-cardiomyopathy


Diagnosis

ECG

  • Low amplitude QRS

Management

  • Treat underlying cause

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