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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