Snapshot A 44-year-old female presents to the emergency department complaining of shortness of breath. For the past several years she has suffered from chronic, progressive, congestive heart failure due to an inflammatory infiltrative process. Introduction Restrictive cardiomyopathy usually presents progressively worsening over time Caused by chronic, progressive, infiltrative or metabolic diseases including amyloidosis sarcoidosis hemochromatosis cancer endocardial fibroelastosis Loffler's endocardial fibrosis glycogen storage diseases Presentation Symptoms chronic, progressively worsening symptoms cough dyspnea fatigue edema Physical exam JVD hepatomegaly crackles of auscultation distant heart sounds pale skin weak pulses Evaluation Echocardiography is diagnostic shows LVH Tissue biopsy is required to determine underlying cause EKG demonstrates low voltage in all leads Differential Other cardiomyopathies, and other causes of CHF Treatment Directed at underlying infiltrative or metabolic process(es) Hemochromatosis is only reversible cause treat with phlebotomy Diuretics for CHF symptoms Prognosis, Prevention, and Complications Prognosis and prevention depend on underlying infiltrative or metabolic process Complications include arrhythmias mitral regurgitation tricuspid regurgitation progression to severe CHF