Restrictive Cardiomyopathy
Last modified: 23 August 2022, 2:24:39 PM AEST
Gems / Priorities1 / 8
- DD = constrictive pericarditis
Definition / diagnostic criteria2 / 8
- diastolic failure
Epidemiology3 / 8
- Overview
- relatively rare
- Incidence
- Prevalence
- Gender
Aetiology / Causes / Risk Factors4 / 8
- primary
- EMG = Loffler's endocarditis = endomyocardial fibrosis
- idiopathic
- tropic and sub-tropical
- eosinophilic infiltration
- idiopathic RCM
- EMG = Loffler's endocarditis = endomyocardial fibrosis
- secondary
- infiltrative = amyloidosis, sarcoidosis
- storage disease = haemochromatosis, glycogen
- CT disease = systemic sclerosis
- radiation-induced CM
Management5 / 8
- HTX only definitive management
Anaesthetic considerations6 / 8
- Pre-op
- Intra-op
- similar to tamponade = fast, full, tight
- caution BB
- CO is HR-dependent = fixed SV
- HR = fast, avoid bradycardia (SV is relatively fixed)
- RHY = SINUS = atrial kick important
- PL = maintain normovolaemia
- INO = maintain
- AL = maintain = CPP with LVEDP
- Post-op
Common questions / related topics7 / 8
Restrictive CM vs constrictive pericarditis
- Both lead to diastolic heart failure
- RCM
- ⬇compliance from abnormal elastic properties of myocardium
- S3 common = abrupt cessation of rapid ventricular filling
- S4 in some cases
- Atrial enlargement usually severe
- Cardiac catherisation
- LVEDP > RVEDP
- BNP much higher (⬆wall stretch)
- Constrictive pericarditis
- ⬇compliance from external pericardial constraint
- septum is not involved, and can therefore bulge toward LV when LV volume < RV volume
- Exaggerated interventricular dependence
- Shifting of septum during respiratory cycle
- S3 less common
- No S4
- Pericardial knock = heart sound slightly earlier than S3
- RVEDP and LVEDP equalisation
- https://www.uptodate.com.acs.hcn.com.au/contents/differentiating-constrictive-pericarditis-and-restrictive-cardiomyopathy?acc=36422
- https://www.utmb.edu/pedi_ed/CoreV2/Cardiology/cardiologyV2/cardiologyV213.html