Endomyocardial Fibrosis: Still a Mystery after 60 Years

Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts, USA.
PLoS Neglected Tropical Diseases (Impact Factor: 4.45). 02/2008; 2(2):e97. DOI: 10.1371/journal.pntd.0000097
Source: PubMed


The pathologist Jack N. P. Davies identified endomyocardial fibrosis in Uganda in 1947. Since that time, reports of this restrictive cardiomyopathy have come from other parts of tropical Africa, South Asia, and South America. In Kampala, the disease accounts for 20% of heart disease patients referred for echocardiography. We conducted a systematic review of research on the epidemiology and etiology of endomyocardial fibrosis. We relied primarily on articles in the MEDLINE database with either "endomyocardial fibrosis" or "endomyocardial sclerosis" in the title. The volume of publications on endomyocardial fibrosis has declined since the 1980s. Despite several hypotheses regarding cause, no account of the etiology of this disease has yet fully explained its unique geographical distribution.

Download full-text


Available from: Gene Bukhman, Dec 11, 2014
  • Source
    • ". Among other regions with high level of disease occurrence there are some countries of South America (Brazil and Colombia), many cases were registered in southern China (Guangxi province) (Bukhman et al., 2008). Signs of chronic LEF manifest themselves as cachexia, shortened fingers and toes, and growth inhibition. "
    [Show abstract] [Hide abstract]
    ABSTRACT: New data on the abundance of rare earth elements (REE) and their biological properties, which appeared in recent decades, force the researchers to reconsider the facts previously collected by different researchers related to the study of the geophagia phenomenon in animals and humans. From the standpoint of the new data it becomes apparent that one of the reasons for instinctively traditional form of geophagia, as well as for drinking water from mineralized sources by animals and a man with lengthy visits to the same places could be an instinctual drive of a specific organism to adjust in their bodies and tissues the concentration and ratio of the rare earth elements which are able to actively influence, either directly or indirectly (through the effects on metabolism of other chemical elements in the body) the biochemical and physiological processes that determine the quality of health. Since REE influence at the level of nerve tissue biochemistry, hormonal regulation of the body and even at the genetic level, it all can point to a higher order which they occupy in the hierarchy of elements in the composition of any organism. It seems that REE have reasons to claim to be the main causes of all instinctive forms of traditional geophagia and related consumption of mineralized water.
    Full-text · Article · Dec 2015
  • Source
    • "Clinical research should be coupled with investigations into the biologic basis for various forms of HF. For example, increasing access to echocardiography and early diagnosis may foster a better understanding of EMF while exploration of molecular mechanisms may uncover therapeutic targets [171]. Lastly, where the causes and treatments for some conditions are well known (e.g., RHD, hypertensive heart disease), these conditions still contribute to significant morbidity and mortality on the continent. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The heart failure syndrome has been recognized as a significant contributor to cardiovascular disease burden in sub-Saharan African for many decades. Seminal knowledge regarding heart failure in the region came from case reports and case series of the early 20th century which identified infectious, nutritional and idiopathic causes as the most common. With increasing urbanization, changes in lifestyle habits, and ageing of the population, the spectrum of causes of HF has also expanded resulting in a significant burden of both communicable and non-communicable etiologies. Heart failure is sub-Saharan Africa is notable for the range of etiologies that concurrently exist as well as the healthcare environment marked by limited resources, weak national healthcare systems and a paucity of national level data on disease trends. With the recent publication of the first and largest multinational prospective registry of acute heart failure in sub-Saharan Africa, it is timely to review the state of knowledge to date and describe the myriad forms of heart failure in the region. This review discusses several forms of heart failure that are common in sub-Saharan Africa [e.g., rheumatic heart disease, hypertensive heart disease, pericardial disease, various dilated cardiomyopathies, HIV cardiomyopathy, hypertrophic cardiomyopathy, endomyocardial fibrosis, ischemic heart disease, cor pulmonale] and presents each form with regard to epidemiology, natural history, clinical characteristics, diagnostic considerations and therapies. Areas and approaches to fill the remaining gaps in knowledge are also offered herein highlighting the need for research that is driven by regional disease burden and needs.
    Full-text · Article · Apr 2013 · Current Cardiology Reviews
  • Source
    • "Historically, one of the most intriguing aspects of the disease is its peculiar occurrence in certain pockets of the world4. The disease is most common in the tropics 15° on either side of the equator5. Isolated case reports have been published from various parts of the world but many of these patients had long stay in the regions of endemicity. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Tropical endomyocardial fibrosis in India was a common medical problem in the coastal districts of south India, especially the Kerala State. The clinical and autopsy studies have shown left and right ventricular apical fibrosis, with varying degree of atrioventricular valve regurgitation. Left ventricular endomyocardial fibrosis presents with severe pulmonary hypertension and right ventricular endomyocardial fibrosis presents very high systemic venous pressure and congestive cardiac failure. Surgical management improved the natural history of the disease to some extent. Various infectious and toxic factors were postulated regarding its aetiology. During the last few years, incidence of the disease has decreased considerably. The only explanation identified is the significant improvement in the living standards of the people with the corresponding decline in the childhood malnutrition, infections, worm infestation and associated eosinophilia.
    Full-text · Article · Nov 2012 · The Indian Journal of Medical Research
Show more