Abstract
Endomyocardial fibrosis (EMF) is a disease that known to cause
restrictive cardiomyopathy. It shows high prevalence in tropical
country. Several triggering factors has been proposed, however, the
pathogenesis is still mystery. The disease is progressive in nature and
the outcome is generally unfavorable. Most common symptoms is heart
failure, however, atypical presentation may expected.
Our case presented with symptoms suggestive of ischemia and missed
diagnosed initially as ischemic cardiomyopathy. The aim of this report
is to increase the attention and awareness for this disease.
We present a case of a 53-year-old man referred to emergency department
for sudden chest pain, left sided and non-radiating lasted for several
minutes, awoke him from sleep with no associated symptoms. He is known
to have Diabetes type-2 and hypertension on oral therapy. Cardiac
markers were within normal limit. The patient discharged home with
appointment to cardiology out-patient clinic. Echocardiography done and
revealed mildly reduced left ventricular (LV) systolic function Ejection
Fraction of 46 %, asymmetric LV hypertrophy affecting the apical
segments with aneurysm and calcified apical thrombus. CT coronary
angiography done with non-significant Left Anterior Descending artery
lesions and left ventricular hypertrophy affecting the apex with
calcified apical thrombus. Further investigation by cardiac MRI revealed
apical thrombus and late apical uptake suggesting Endomyocardial
Fibrosis of possible eosinophilic etiology. The patient continued to
have attacks of similar chest pain for which stress cardiac MRI done and
was negative for ischemia. Other diagnostic work-up was done including
hematological and serological tests such as Antinuclear Antibodies and
Schistosoma Antibodies.
The patient was put on valsartan and Bisoprolol with oral anticoagulant
(vitamin K antagonist) and Rosuvastatin.
Conclusion: EMF may have heterogeneous presentation and should be
considered in patient with calcific apical thrombus without previous
history of cardiac problem, even in non-tropical region
Introduction:Endomyocardial fibrosis (EMF) is a progressive restrictive
cardiomyopathy that usually affects the left, right, or both ventricles.
It can also affect the outflow of the ventricles, leading to the
development of symptoms of failure of the involved ventricle (1). The
restrictive involvement is usually seen because of apical fibrosis which
usually arises from collagen deposition and fibroblast proliferation. It
is prevalent in tropical and subtropical parts of the world. The main
cause of it is still unknown, however, there are multiple theories
available regarding its development (2). Treatment is challenging as
currently there is limited data, medical therapy as a case of
restrictive heart failure might offer a symptomatic relief, however the
disease is usually progressive, and the long-term outcome is generally
poor. On the other hand, surgical resection of the endocardium might
offer a definite treatment however there is still a risk of recurrence,
and it carries a high mortality rate (3).
We report a patient who presented with chest pain and on subsequent
investigations were diagnosed with EMF. The patient has frequent visit
to Heart failure clinic, and he is doing well.
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