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A Challenging Differential Diagnosis: Distinguishing between Endomyocardial Fibrosis and Apical Hypertrophic Cardiomyopathy
Author(s) -
Maia Cintia Prado,
Gali Luís Gustavo,
Schmidt André,
Almeida Filho Oswaldo César,
Santos Marcel Koenigkam,
Saraiva Luciano Albuquerque Lima,
Rodrigues Alfredo José,
Maciel Benedito Carlos,
Romano Minna Moreira Dias
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13244
Subject(s) - endomyocardial fibrosis , medicine , cardiology , hypertrophic cardiomyopathy , restrictive cardiomyopathy , muscle hypertrophy , fibrosis , cardiomyopathy , left ventricular hypertrophy , stenosis , diastole , heart failure , blood pressure
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.