A Challenging Differential Diagnosis: Distinguishing between Endomyocardial Fibrosis and Apical Hypertrophic Cardiomyopathy

Endomyocardial fibrosis, which is a cause of restrictive cardiomyopathy, is characterized by the deposition of fibrous tissue in the apical region of 1 or both ventricles. The condition not only affects the diastolic dynamics of the ventricles, but also the function of the atrioventricular valves. T...

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Bibliographic Details
Published in:Echocardiography (Mount Kisco, N.Y.) N.Y.), 2016-07, Vol.33 (7), p.1080-1084
Main Authors: Maia, Cintia Prado, Gali, Luís Gustavo, Schmidt, André, de Almeida Filho, Oswaldo César, Santos, Marcel Koenigkam, Saraiva, Luciano Albuquerque Lima, Rodrigues, Alfredo José, Maciel, Benedito Carlos, Romano, Minna Moreira Dias
Format: Article
Language:English
Subjects:
Cardiac Imaging Techniques - methods
cardiac magnetic resonance
Cardiomyopathy, Hypertrophic - diagnostic imaging
Cardiomyopathy, Restrictive - diagnostic imaging
Cardiomyopathy, Restrictive - etiology
Diagnosis, Differential
echocardiography
Echocardiography - methods
endomyocardial fibrosis
Endomyocardial Fibrosis - complications
Endomyocardial Fibrosis - diagnostic imaging
Heart Ventricles - diagnostic imaging
Humans
Magnetic Resonance Imaging, Cine - methods
Male
Middle Aged
restrictive cardiomyopathy
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Summary:Endomyocardial fibrosis, which is a cause of restrictive cardiomyopathy, is characterized by the deposition of fibrous tissue in the apical region of 1 or both ventricles. The condition not only affects the diastolic dynamics of the ventricles, but also the function of the atrioventricular valves. The disease occurs predominantly in tropical regions worldwide and in sub‐Saharan Africa. This condition is not well understood, with varied manifestations, from subclinical presentations to chronic and progressive edematous syndromes. Here, we present the challenging case of a patient with an indeterminate echocardiographic image, suggesting apical hypertrophy, plus severe aortic stenosis and fibrosis of the left ventricular outflow tract. An electrocardiogram revealed symmetrical T‐wave inversion, which is a characteristic manifestation of apical hypertrophy. The importance of cardiac imaging examinations such as echocardiography and cardiac magnetic resonance for differentiating between endomyocardial fibrosis and apical hypertrophy is highlighted in this patient's case.
ISSN:0742-2822
1540-8175
DOI:10.1111/echo.13244