Restrictive Cardiomyopathy (RCM)

Maintain preload - Stroke volume is fixed and filling-dependent; avoid hypovolemia and venodilation, but titrate fluids carefully because the stiff ventricle congests easily - the safe window is narrow.

Avoid tachycardia - A fast rate shortens diastole and worsens filling of a stiff ventricle; keep the rate controlled.

Preserve sinus rhythm - The atrial kick is critical and atrial fibrillation is poorly tolerated; treat new AF aggressively.

Maintain contractility and afterload - Avoid myocardial depressants and frank hypotension to protect coronary perfusion.

Monitoring and cause - Use invasive monitoring for significant disease, and pursue the underlying cause (amyloid, sarcoid, iron overload), which carries its own anesthetic implications.

A cardiomyopathy of stiff, non-compliant ventricles with impaired diastolic filling but preserved or near-normal systolic function and non-dilated chambers. Causes include amyloidosis, sarcoidosis, hemochromatosis, endomyocardial fibrosis, and radiation. The result is a fixed, low stroke volume that is highly dependent on preload and heart rate, marked atrial enlargement with a tendency to atrial fibrillation, and heart-failure symptoms with a preserved ejection fraction. It behaves much like constrictive pericarditis.