Restrictive Cardiomyopathy

ECG Features of Restrictive Cardiomyopathy

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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

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Example ECG

ECG of a patient with restrictive cardiomyopathy, demonstrating:

• Low voltage QRS complexes
• Widespread flattening of T waves

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References

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Advanced Reading

Online

Textbooks

• Zimmerman FH. ECG Core Curriculum. 2023
• Mattu A, Berberian J, Brady WJ. Emergency ECGs: Case-Based Review and Interpretations, 2022
• Straus DG, Schocken DD. Marriott’s Practical Electrocardiography 13e, 2021
• Brady WJ, Lipinski MJ et al. Electrocardiogram in Clinical Medicine. 1e, 2020
• Mattu A, Tabas JA, Brady WJ. Electrocardiography in Emergency, Acute, and Critical Care. 2e, 2019
• Hampton J, Adlam D. The ECG Made Practical 7e, 2019
• Kühn P, Lang C, Wiesbauer F. ECG Mastery: The Simplest Way to Learn the ECG. 2015
• Grauer K. ECG Pocket Brain (Expanded) 6e, 2014
• Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric 6e, 2008
• Chan TC. ECG in Emergency Medicine and Acute Care 1e, 2004

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LITFL Further Reading

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