digoxin and Endomyocardial-Fibrosis

Endomyocardial fibrosis is a variety of restrictive cardiomyopathy, in which endocardium of one or both ventricles is thickened markedly with involvement of underlying myocardium. Partial obliteration of ventricular cavities by fibrous tissue and thrombus causes diastolic dysfunction with increased resistance to ventricular filling. Systolic function is well preserved till late stages. Biventricular or isolated left ventricular involvement is common. Isolated right ventricular involvement is relatively uncommon. Case reports on endomyocardial fibrosis have declined in literature. In India, endomyocardial fibrosis is mainly reported from Kerala. A case of right ventricular endomyocardial fibrosis from West Bengal is reported here. Isolated right sided endomyocardial fibrosis, massive right atrial enlargement, complete disorganization of tricuspid valve, massive pericardial effusion, normal absolute eosinophil count and its sporadic occurrence outside 15 degrees of the equatorial belt were interesting features in this case of endomyocardial fibrosis. X-ray features were typical of pericardial effusion masking underlying endomyocardial fibrosis. Endomyocardial fibrosis is a neglected research field. It needs more attention from biomedical researchers.

Topics: Adult; Anticoagulants; Cardiomyopathy, Restrictive; Cardiotonic Agents; Digoxin; Diuretics; Echocardiography; Endomyocardial Fibrosis; Female; Heart Ventricles; Humans; Pericardial Effusion; Treatment Outcome; Tricuspid Valve

A 34-year-old previously healthy woman was admitted to another hospital because of abdominal pain, cough and dyspnea. Peripheral eosinophilia was present. Two months later she was admitted to the cardiology department with signs of mitral regurgitation. Dyspnea, fatigue, skin rashes with pruritus and a systolic murmur were noted.. Laboratory tests showed 11.4/nl leukocytes (normal range 4.8-10.8/nl) with an eosinophilia of 19% (normal range < 4%) corresponding to 2.2/nl. Cardiac magnetic resonance imaging revealed endomyocardial fibrosis involving the posterior mitral leaflet with resulting valvular regurgitation. Doppler ultrasound showed restrictive heart failure. DIAGNOSIS, THERAPY AND FURTHER COURSE: The diagnosis of idiopathic hypereosinophilia most likely as part of hypereosinophilic syndrome with cardiac involvement was made. The patient was treated with digitalis, diuretics and peptidyl dipeptidase (PDP) inhibitor. The treatment with glucocorticoids and cytotoxic agent to achieve a reduction of eosinophil count was ended by the patient a few weeks later.. The hypereosinophilic syndrome with endomyocardial fibrosis is rare, and its prognosis is grave. The pathophysiological mechanisms are not entirely clear, nearly 70 years after Löffler first described fibrous endocarditis with eosinophilia. Patients receive symptomatic medical therapies. Additional surgical treatment has been reported,. Antihypereosinophilic therapy is used to control the disease.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cardiomyopathy, Restrictive; Cardiotonic Agents; Diagnosis, Differential; Digoxin; Diuretics; Drug Therapy, Combination; Echocardiography, Doppler; Enalapril; Endomyocardial Fibrosis; Female; Humans; Hypereosinophilic Syndrome; Magnetic Resonance Imaging; Mineralocorticoid Receptor Antagonists; Mitral Valve Insufficiency; Patient Compliance; Prognosis; Spironolactone; Sulfonamides; Torsemide

Topics: Adult; Diagnosis, Differential; Digoxin; Diuretics; Endomyocardial Fibrosis; Female; Humans; Male; Middle Aged; Ohio

Topics: Antitubercular Agents; Child; Child, Preschool; Diagnosis, Differential; Digoxin; Diuretics; Endomyocardial Fibrosis; Female; Humans; Infant; Male; Pericardial Effusion; Prednisone; Tuberculosis, Cardiovascular; Tuberculosis, Pulmonary; Uganda

Topics: Anemia; Atrial Fibrillation; Black People; Blood Pressure; Cardiac Catheterization; Cardiac Output; Digoxin; Electrocardiography; Endomyocardial Fibrosis; Heart Rate; Heart Ventricles; Hemodynamics; Hemoglobinometry; Humans; Oxygen; Pericarditis, Constrictive; Strophanthins; Uganda

Topics: Adult; Africa, Central; Black or African American; Black People; Diagnosis, Differential; Digoxin; Endocarditis, Bacterial; Endomyocardial Fibrosis; Heart Failure; Humans; Mitral Valve Stenosis; Organomercury Compounds; Pulmonary Edema; Tropical Medicine