A case of endomyocardial fibrosis mimicking rheumatic valvular heart disease

Abstract

Tropical endomyocardial fibrosis (EMF) affects majorly the low socio-economic population of the tropical and subtropical rainforest regions of the World. Though there is a recognized global reduction in the prevalence of EMF, one of the contributing factors is misdiagnosis as Rheumatic heart disease (RHD) which is also a prevalent disease in the endemic zone. We present a 38-yr old woman with a 4-week history of progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnea, bilateral leg and
abdominal swelling. Patient was initially managed as a case of heart failure secondary to rheumatic heart disease at a peripheral hospital. Chest X- ray revealed cardiomegaly, electrocardiography showed atrial fibrillation with rapid ventricular response while Echocardiography showed mild pericardial effusion, right ventricular apical fibrosis, right ventricular dilatation with reduced systolic function, bi-atrial enlargement, dilated pulmonary trunk, right ventricular restrictive diastolic pattern and
evidence of pulmonary hypertension (estimated mean pulmonary arterial pressure 45mmHg). A final diagnosis of heart failure secondary to Endomyocardial fibrosis complicated by atrial fibrillation and pulmonary hypertension was made. This case report highlights the need for physician to look out for cases of EMF especially in suspected cases of RHD which is a close differential and strong mimic of EMF in the endemic regions.