7th March 2024

Signs and symptoms

RCM leads to increased myocardial stiffness. By the time of diagnosis, this has usually led to typical signs of heart failure described above, such as dyspnoea, fatigue, and pulmonary and peripheral oedema, but due to the increased ventricular stiffness on examination, you may also hear a loud third heart sound, due to abrupt cessation of rapid ventricular filling.

A majority of patients with RCM will also develop atrial fibrillation due to elevated filling pressures and subsequent left atrial enlargement, the latter of which is strongly correlated with the presence of atrial fibrillation. This will lead to the presence of an irregularly irregular pulse and may lead to patients experiencing palpitations alongside worsening dyspnoea and presyncope.

RCM is most commonly idiopathic in nature, with amyloidosis being the most common identifiable cause. If amyloid is discovered, then the patient may manifest other signs and symptoms of the underlying pathology, such as features of myeloma in AL amyloid, signs of iron deposition such as a change in skin colour and liver failure in haemochromatosis or carpal tunnel syndrome due to systemic amyloid deposition.