Restrictive Cardiomyopathy

ECG Features of Restrictive Cardiomyopathy

Pathophysiology

Restrictive cardiomyopathy is the least common form of cardiomyopathy. It occurs in the advanced stages of myocardial infiltrative disease — e.g. due to haemochromatosis, amyloidosis or sarcoidosis.

• Diffuse myocardial infiltration leads to low voltage QRS complexes.
• Atrial fibrillation may occur due to atrial enlargement; ventricular arrhythmias are also common
• Infiltration of the cardiac conducting system (e.g. due to septal granuloma formation in sarcoidosis) may lead to conduction disturbance — e.g. bundle branch blocks and AV block.
• Healing granulomas in sarcoidosis may produce “pseudo-infarction” Q waves

Example ECG

ECG of a patient with restrictive cardiomyopathy, demonstrating:

• Low voltage QRS complexes
• Widespread flattening of T waves

Related Topics

• Low QRS voltage
• Hypertrophic cardiomyopathy

References

• Edhouse J, Thakur RK, Khalil JM. ABC of clinical electrocardiography. Conditions affecting the left side of the heart. BMJ. 2002 May 25;324(7348):1264-7

Advanced Reading

Online

• Wiesbauer F, Kühn P. ECG Mastery: Yellow Belt online course – Become an ECG expert. Medmastery
• Wiesbauer F, Kühn P. ECG Blue Belt online course: Learn to diagnose any rhythm problem. Medmastery
• Rawshani A. Clinical ECG Interpretation ECG Waves
• Smith SW. Dr Smith’s ECG blog.

Textbooks

• Mattu A, Tabas JA, Brady WJ. Electrocardiography in Emergency, Acute, and Critical Care. 2e, 2019
• Brady WJ, Lipinski MJ et al. Electrocardiogram in Clinical Medicine. 1e, 2020
• Straus DG, Schocken DD. Marriott’s Practical Electrocardiography 13e, 2021
• Hampton J. The ECG Made Practical 7e, 2019
• Grauer K. ECG Pocket Brain (Expanded) 6e, 2014
• Brady WJ, Truwit JD. Critical Decisions in Emergency and Acute Care Electrocardiography 1e, 2009
• Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric 6e, 2008
• Mattu A, Brady W. ECG’s for the Emergency Physician Part I 1e, 2003 and Part II
• Chan TC. ECG in Emergency Medicine and Acute Care 1e, 2004
• Smith SW. The ECG in Acute MI. 2002 [PDF]

LITFL Further Reading

• ECG Library Basics – Waves, Intervals, Segments and Clinical Interpretation
• ECG A to Z by diagnosis – ECG interpretation in clinical context
• ECG Exigency and Cardiovascular Curveball – ECG Clinical Cases
• 100 ECG Quiz – Self-assessment tool for examination practice
• ECG Reference SITES and BOOKS – the best of the rest