Restrictive Cardiomyopathy Overview

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.

ECG Features of Restrictive Cardiomyopathy

• Low voltage QRS complexes
• Non-specific ST segment / T wave changes
• Bundle branch blocks
• Atrioventricular block (3rd degree AV block may occur in sarcoidosis)
• Pathological Q waves
• Atrial and ventricular dysrhythmias

Example ECGs

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. [PMC1123219].

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

Advanced Reading

• Brady WJ, Truwit JD. Critical Decisions in Emergency and Acute Care Electrocardiography
• Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric
• Wagner GS. Marriott’s Practical Electrocardiography 12e
• Chan TC. ECG in Emergency Medicine and Acute Care
• Rawshani A. Clinical ECG Interpretation
• Mattu A. ECG’s for the Emergency Physician
• Hampton JR. The ECG In Practice, 6e