Endomyocardial Fibrosis

Endomyocardial fibrosis  is an idiopathic disorder that is characterized by the development of restrictive cardiomyopathy in tropical and subtropical regions of the world. EMF nosology coincides with some of the related disorders. EMF is sometimes seen as part of a spectrum of a single disease process involving endocarditis of Löeffler. EMF is a mysterious disease with still unraveling etiology. The afflicted individuals are mostly young women and children who succumb to high morbidity rates, and heart failure mortality. Both medical and surgical treatments are practiced with results that vary from temporary symptom relief to surgery with high mortality rates. A Mozambique echocardiographic screening study found a population prevalence of 20 percent, but this study included patients with early, subclinical disease. In subtropical regions also EMF occurs. EMF is characterized by fibrous tissue replacing the endocardium and myocardium, which results in a restrictive functional state. Olsen acknowledged three eMF phases. The first phase duration may reach five months, and is characterized by myocardium eosinophilic infiltration with subendocardium necrosis; an image consistent with acute myocarditis. Myocardial involvement has been considered a manifestation of the eosinophilic endomyocardial disease acute necrotic stage. The combination of environmental, infectious and other unknown factors in susceptible individuals leads to endomyocardial damage and the formation of scars. This progression from inflammation to the fibrotic stage takes different pathological forms and actually passes through acute myocarditis, necrotic and thrombotic phases which eventually end in the fibrotic stage. 

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