CLINICAL AND HAeMODYNAMIC PATTERNS IN ENDOMYOCARDIAL FIBROSIS

Abstract

Fifteen patients with endomyocardial fibrosis in East Africans were studied clinically and by phonocardiography, electrocardiography, and cardiac catheterization. The disease particularly affects the endocardium and myocardium of the ventricles and may involve the mitral and tricuspid valves to produce valvular regurgitation. The lesions may occur separately or in any combination, and examples of each type are described. The patients presented with signs of heart failure including breathlessness, palpitation, edema, ascites, and hepatic pain. The clinical findings were those of heart failure associated with a constructive picture of either the right ventricle or the left ventricle; mitral regurgitation was a common finding and tricuspid regurgitation was found less often. Cardiac catheterization showed there was a raised left atrial pressure in the majority of cases with a moderately raised pulmonary artery pressure; in one instance the systolic pulmonary arterial pressure was as high as 90 mm Hg. The right ventricular pressure curve showed in most patients a raised end diastolic pressure and when the disease was advanced, a grossly abnormal pulse with attenuated systolic wave. The right atrial pressure was usually raised and often resembled that found in constrictive pericarditis. The relationship of the clinical picture to the hemodynamic findings is discussed.