digoxin and Pericardial-Effusion

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

The primary cause of cardiac dysfunction in thalassemia is believed to be myocardial iron overload. Besides iron, other factors may play a role in the impairment of myocardial contractility, including prolonged heart tissue hypoxia, pericardial involvement, arrhythmias, endocrine complications and vitamin D deficiency. We present the case of a 7 year-old boy with ?-thalassaemia major and cardiac dysfunction, pericardial effusion and associated endocrinopathies. His serum thyrotropin (TSH) level was increased, and total and free thyroxine (FT4) were low. In addition, biochemical results and serum PTH level were compatible with a diagnosis of hypoparathyroidism. Other laboratory findings were not consistent with rheumatic heart disease, viral myocarditis or autoimmune disease. The child was treated with digoxin, diuretics, oral calcium, vitamin D, L-thyroxine (25 microg daily, which was later gradually increased) and subcutaneous iron chelation therapy (45 mg/kg, six days/week). The patient was discharged from our Unit after 7 days and within 3 months he had appreciable myocardial improvement and disappearance of the pericardial effusion.

Topics: beta-Thalassemia; Calcium; Cardiomyopathies; Cardiotonic Agents; Child; Digoxin; Diuretics; Humans; Hypoparathyroidism; Hypothyroidism; Iron Chelating Agents; Iron Overload; Male; Pericardial Effusion; Thyroxine

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