Restrictive cardiomyopathy vs Constrictive pericarditis
How to tell Restrictive cardiomyopathy and Constrictive pericarditis apart when a board question makes them look alike.
Restrictive is stiff myocardium; constrictive is stiff pericardium with exaggerated ventricular interdependence.
Side by side
Diastolic dysfunction from stiff myocardium, often due to infiltrative disease.
Diastolic dysfunction from rigid pericardium, often with pericardial calcification or knock.
The ventricular muscle itself cannot relax or fill normally.
A scarred pericardial shell mechanically limits filling.
Biatrial enlargement and infiltrative clues support restrictive cardiomyopathy; amyloid may show low-voltage ECG despite thick ventricular walls.
Pericardial calcification, ventricular interdependence, and respiratory variation in mitral inflow support constriction.
The trap
Both cause diastolic failure with preserved ejection fraction, biatrial enlargement, Kussmaul sign, and right-sided congestion, so the clinical picture is nearly identical. The discriminator is the pericardium. Pericardial calcification or thickening above 3 mm on CT/MRI, a pericardial knock on auscultation, and respiratory variation in ventricular inflow with ventricular interdependence on echo point to constriction. Restriction shows biventricular wall thickening with a normal pericardium; amyloid is the high-yield restrictive cause, with paradoxically low-voltage ECG despite thick walls and apical sparing on strain imaging.
Watch it explained
The repair move
For diastolic filling disease, identify whether stiffness is myocardial infiltration or an external pericardial shell with respiratory inflow variation.
Try a free question
CoreA patient with amyloidosis has heart failure symptoms, preserved systolic function, biatrial enlargement, and impaired ventricular filling from stiff myocardium. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Restrictive cardiomyopathy. Infiltrative myocardial stiffness causing diastolic dysfunction points to restrictive cardiomyopathy.
Why the other choices are tempting
- B. Constrictive pericarditis is a rigid pericardial shell, often with calcification.
- C. Dilated cardiomyopathy causes systolic dysfunction and chamber dilation.
- D. HCM causes asymmetric septal hypertrophy and dynamic obstruction.
- E. Tamponade is acute pericardial pressure impairing filling.
Flashcards
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What is the fastest separator for Restrictive cardiomyopathy vs Constrictive pericarditis?
Restrictive is stiff myocardium; constrictive is stiff pericardium with exaggerated ventricular interdependence.
What clue should make you choose Restrictive cardiomyopathy?
Diastolic dysfunction from stiff myocardium, often due to infiltrative disease.
Quick answers
What is the fastest way to tell Restrictive cardiomyopathy from Constrictive pericarditis?
Restrictive is stiff myocardium; constrictive is stiff pericardium with exaggerated ventricular interdependence.
What is the key clue for Restrictive cardiomyopathy?
Diastolic dysfunction from stiff myocardium, often due to infiltrative disease.
What is the key clue for Constrictive pericarditis?
Diastolic dysfunction from rigid pericardium, often with pericardial calcification or knock.
What is the common trap with Restrictive cardiomyopathy vs Constrictive pericarditis?
Both cause diastolic failure with preserved ejection fraction, biatrial enlargement, Kussmaul sign, and right-sided congestion, so the clinical picture is nearly identical. The discriminator is the pericardium. Pericardial calcification or thickening above 3 mm on CT/MRI, a pericardial knock on auscultation, and respiratory variation in ventricular inflow with ventricular interdependence on echo point to constriction. Restriction shows biventricular wall thickening with a normal pericardium; amyloid is the high-yield restrictive cause, with paradoxically low-voltage ECG despite thick walls and apical sparing on strain imaging.