Case Spotlight

The Addis Clinic connects physicians to patients – that is the foundation of our work. We want to give you a look inside a case our physicians consult on.

A 50-year-old male with no known medical history came to a clinic in Guyana complaining about shortness of breath and a cough for at least three weeks. The resident physician uploaded the history, EKG, and ultrasound movies of the patient’s heart, and he was unsure if the patient could have infectious cardiomyopathy (enlargement and dysfunction of the heart), possibly related to tuberculosis. After reviewing the images and information, vital signs and lab results, our cardiologist determined the patient was suffering from restrictive cardiomyopathy, complicated by clots in the heart and overt heart failure. More specifically, the entire case was consistent with endomyocardial fibrosis. Translated into non-medical language, it means that the patient had a thickening of the heart muscle with blood clots and both the right and left side of the heart wer not pumping blood adequately throughout the body. Because of that, the heart had to work twice as hard, and that explained the patient’s difficulty with breathing.

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Endomyocardial fibrosis (EMF) was first described in Uganda in 1948. Since then it has been found mostly in tropical and subtropical regions of the world. In the past, researchers thought that EMF is triggered by parasites, worms or poor nutrition, calling it a “neglected disease of poverty that afflicts rural populations in tropical low-income countries.” But no conclusive evidence for that has been found – so the cause of the disease is still unclear. It seems very likely that dietary, infectious, and environmental factors are causing the disease since an improvement of the living standard will lead to decreased number of people affected by EMF.

Because we know so little about what causes EMF, the medical treatment is limited. The recommendation for our patient consisted of medication to prevent blood clots to reduce the risk of a stroke or a heart attack and beta blockers to keep the heart from beating too fast and with too much force. 

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Unfortunately, the general prognosis for patients with EMF is very poor, but with the help of our cardiologist, the cause of the patient’s illness is now known, and appropriate management and treatment will be initiated.

(Credits: Tropical Endomyocardial Fibrosis – Natural History, Challenges, and Perspectives, Circulation, June 13, 2016. Photo credits: Shawn Brandow, Marian Gurry Stanton)