What is Restrictive Cardiomyopathy?

Restrictive cardiomyopathy is a condition in which the walls of the lower chambers of the heart become too rigid to expand as the ventricles fill with blood. The heart’s ability to pump blood may be normal, but its ability to fill with blood is abnormal. As a result, the heart eventually loses its ability to pump properly, and primary restrictive cardiomyopathy leads to heart failure.

Restrictive Cardiomyopathy Symptoms

Patients with restrictive cardiomyopathy may experience only minor symptoms, or no symptoms at all. Others will develop symptoms that progress as the heart becomes weaker. Below is a list of restrictive cardiomyopathy symptoms.

• Shortness of breath
• Fatigue
• Weight gain
• Swelling in the legs and feet
• Nausea
• Bloating
• Loss of appetite
• Heart palpitations
• Chest pain
• Fainting

Restrictive Cardiomyopathy Causes

Restrictive cardiomyopathy is not usually inherited and often the cause is unknown. Some of the most common causes of restrictive cardiomyopathy are:

• Build-up of scar tissue
• Build-up of abnormal proteins (amyloidosis)
• Excess iron (hemochromatosis)
• Chemotherapy or radiation
• Inflammation (sarcoidosis)
• Tumors

Restrictive Cardiomyopathy Diagnosis

Restrictive cardiomyopathy is sometimes confused with pericarditis, which is an inflammation of the thin tissue sac that surrounds the heart. Different diagnostic tools are used to help doctors make a distinction between the two conditions. To determine if a patient has primary restrictive cardiomyopathy, a doctor will consider symptoms and family history of heart disease. The following tests may be used to help make a diagnosis of restrictive cardiomyopathy:

• Physical exam: The doctor will go over a patient’s history and check vital signs, including heart rate. This will help establish a baseline for determining any changes that may indicate the presence of primary restrictive cardiomyopathy.
• Electrocardiogram: This test records the electrical activity of the heart. It examines the heart’s rhythm and blood flow and can detect abnormalities.
• Chest x-ray: A chest x-ray will help reveal the cause of restrictive cardiomyopathy, such as inflammation. It may also help rule out restrictive cardiomyopathy by showing findings that are more consistent with a pericarditis diagnosis.
• Echocardiogram: This test is key in diagnosing restrictive cardiomyopathy. It can reveal enlargement of the upper chambers of the heart and thickening of the leaflets. It shows the stiffening of the walls of the lower chambers of the heart, which characterize restrictive cardiomyopathy.
• Exercise stress test: An exercise stress test shows how the heart operates during physical activity. Since exercise makes the heart pump harder, this test helps show how blood flows through the heart.
• CT scan: A heart CT scan produces detailed images of the heart and its blood vessels. This test will help show if the heart is enlarged.
• MRI: This diagnostic tool uses a magnetic field and radio waves to create 2-D and 3-D images of the heart. It is very accurate in helping to differentiate restrictive cardiomyopathy from pericarditis.
• Blood tests: A CBC (complete blood cell) count will determine the presence of infections. A blood gas analysis will determine the level of oxygen in the blood.
• Cardiac catheterization: During this test, a long thin tube is inserted into an artery in the groin and guided to the heart. Damage to the heart muscle, valves and arteries can be determined, and blood pressure and flow can also be measured.
• Liver biopsy: During this procedure, a small needle is inserted into the liver to remove a sample. This is done to test for excess iron.

Restrictive Cardiomyopathy Treatment

Restrictive cardiomyopathy treatment tends to focus on treating the underlying cause of the condition. Changes in lifestyle can make a difference, as can medications. In some cases, surgery is required to treat restrictive cardiomyopathy.

Lifestyle changes

• Follow a low sodium diet: This can help with restrictive cardiomyopathy symptoms such as shortness of breath, fatigue, weight gain and swelling.
• Exercise: Exercise is good for keeping the heart healthy and helps a person maintain a healthy weight. Patients with restrictive cardiomyopathy may need to take frequent breaks during exercise.

Medications

• Beta blockers: These medications cause the heart to beat more slowly and less forcefully, reducing blood pressure. They increase the time it takes for the left ventricle to fill with blood, giving the walls of the chamber more time to relax.
• Ace inhibitors: Ace inhibitors relax blood vessels and lower blood pressure, improving blood flow. The heart is then able to pump blood to the rest of the body without having to work as hard.
• Digoxin: This medication blocks electrical conduction between the atria and the ventricles, creating slower contraction of the lower chambers of the heart. It controls the movement of calcium, sodium and potassium through the heart and helps the heart beat more regularly.
• Diuretics: These can help reduce swelling.
• Aldosterone inhibitors: These medications block the chemical in the body that leads to salt and fluid build-up and causes heart muscle to stiffen.

Surgery

In the most severe cases, heart transplant is recommended for treating restrictive cardiomyopathy.

Complications from restrictive cardiomyopathy include:

• Stroke (from a blood clot that forms in the heart and travels to the brain)
• Heart failure
• Abnormal heart rhythm
• Sudden cardiac death
• Increased risk during pregnancy

Learn More about Restrictive Cardiomyopathy from Baptist Health

Treating restrictive cardiomyopathy is one example of how the medical professionals at Baptist Health are leading the way in total heart care. Talk to your heart care provider to learn more.

Restrictive Cardiomyopathy Causes

Restrictive cardiomyopathy is not usually inherited and often the cause is unknown. Some of the most common causes of restrictive cardiomyopathy are:

• Build-up of scar tissue
• Build-up of abnormal proteins (amyloidosis)
• Excess iron (hemochromatosis)
• Chemotherapy or radiation
• Inflammation (sarcoidosis)
• Tumors

Restrictive Cardiomyopathy Diagnosis

Restrictive cardiomyopathy is sometimes confused with pericarditis, which is an inflammation of the thin tissue sac that surrounds the heart. Different diagnostic tools are used to help doctors make a distinction between the two conditions. To determine if a patient has primary restrictive cardiomyopathy, a doctor will consider symptoms and family history of heart disease. The following tests may be used to help make a diagnosis of restrictive cardiomyopathy:

• Physical exam: The doctor will go over a patient’s history and check vital signs, including heart rate. This will help establish a baseline for determining any changes that may indicate the presence of primary restrictive cardiomyopathy.
• Electrocardiogram: This test records the electrical activity of the heart. It examines the heart’s rhythm and blood flow and can detect abnormalities.
• Chest x-ray: A chest x-ray will help reveal the cause of restrictive cardiomyopathy, such as inflammation. It may also help rule out restrictive cardiomyopathy by showing findings that are more consistent with a pericarditis diagnosis.
• Echocardiogram: This test is key in diagnosing restrictive cardiomyopathy. It can reveal enlargement of the upper chambers of the heart and thickening of the leaflets. It shows the stiffening of the walls of the lower chambers of the heart, which characterize restrictive cardiomyopathy.
• Exercise stress test: An exercise stress test shows how the heart operates during physical activity. Since exercise makes the heart pump harder, this test helps show how blood flows through the heart.
• CT scan: A heart CT scan produces detailed images of the heart and its blood vessels. This test will help show if the heart is enlarged.
• MRI: This diagnostic tool uses a magnetic field and radio waves to create 2-D and 3-D images of the heart. It is very accurate in helping to differentiate restrictive cardiomyopathy from pericarditis.
• Blood tests: A CBC (complete blood cell) count will determine the presence of infections. A blood gas analysis will determine the level of oxygen in the blood.
• Cardiac catheterization: During this test, a long thin tube is inserted into an artery in the groin and guided to the heart. Damage to the heart muscle, valves and arteries can be determined, and blood pressure and flow can also be measured.
• Liver biopsy: During this procedure, a small needle is inserted into the liver to remove a sample. This is done to test for excess iron.

Restrictive Cardiomyopathy Treatment

Restrictive cardiomyopathy treatment tends to focus on treating the underlying cause of the condition. Changes in lifestyle can make a difference, as can medications. In some cases, surgery is required to treat restrictive cardiomyopathy.

Lifestyle changes

• Follow a low sodium diet: This can help with restrictive cardiomyopathy symptoms such as shortness of breath, fatigue, weight gain and swelling.
• Exercise: Exercise is good for keeping the heart healthy and helps a person maintain a healthy weight. Patients with restrictive cardiomyopathy may need to take frequent breaks during exercise.

Medications

• Beta blockers: These medications cause the heart to beat more slowly and less forcefully, reducing blood pressure. They increase the time it takes for the left ventricle to fill with blood, giving the walls of the chamber more time to relax.
• Ace inhibitors: Ace inhibitors relax blood vessels and lower blood pressure, improving blood flow. The heart is then able to pump blood to the rest of the body without having to work as hard.
• Digoxin: This medication blocks electrical conduction between the atria and the ventricles, creating slower contraction of the lower chambers of the heart. It controls the movement of calcium, sodium and potassium through the heart and helps the heart beat more regularly.
• Diuretics: These can help reduce swelling.
• Aldosterone inhibitors: These medications block the chemical in the body that leads to salt and fluid build-up and causes heart muscle to stiffen.

Surgery

In the most severe cases, heart transplant is recommended for treating restrictive cardiomyopathy.

Complications from restrictive cardiomyopathy include:

• Stroke (from a blood clot that forms in the heart and travels to the brain)
• Heart failure
• Abnormal heart rhythm
• Sudden cardiac death
• Increased risk during pregnancy

Learn More about Restrictive Cardiomyopathy from Baptist Health

Treating restrictive cardiomyopathy is one example of how the medical professionals at Baptist Health are leading the way in total heart care. Talk to your heart care provider to learn more.