Tropical Endomyocardial Fibrosis (EMF)

snrunken ventnoes

Hallmark chronic EMF features include:

 • Apical obliteration of the left and/or right ventricles with fibrous tissue deposition, seen as a 3-layered delayed enhancement pattern of normal myocardium, thickened enhanced endomyocardium with overlying thrombus in cardiac MR (double V sign).

 • Restrictive physiology with shrunken ventricles and marked atria enlargement secondary to fibrosis of the chordae tendineae and papillary muscles leading to mitral and/

Pathogenesis Theories

 • No clear consensus

 • Eosinophilia may play a role

 • Parasitic disease may act as trigger of autoimmunity

 • Linked to malnutrition and environmental factors

 • Genetic susceptibility

Acute Phase

 • Acute febrile illness with nonspecific symptoms

 • Signs of pancarditis with myocardial edema

 • Thromboembolic events may occur

 • Subset evolves into chronic phase

Chronic Phase

 • Restrictive heart failure symptoms

 • Hallmark features seen on cardiac MR

 • Hepatosplenomegaly and disproportional ascites

 • Poor prognosis



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