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Endomyocardial fibrosis is a disease of unknown origin which has not previously been described in detail from the Middle East. The clinical, echocardiographic, hemodynamic and angiocardiographic findings in eight patients (five men and three women, mean age 38 years) are presented. Two patients had right-sided involvement, two had left-sided involvement and four had biventricular involvement. The presence of a small ventricle with obliteration of the apex and a large atrium is a two-dimensional echocardiographic finding highly suggestive of endomyocardial fibrosis. Hemodynamic characteristics of dip and plateau on ventricular pressure curves were present in six patients. Ventricular angiography was diagnostic in all cases. Endomyocardial biopsy yielded positive findings in three of six patients and is not essential for diagnosis.

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A retrospective study of 22 Saudi patients with a diagnosis of dilated cardiomyopathy confirmed by cardiac catheterization was undertaken to study the pattern of this disease in Saudi Arabia. The mean age was 47 years and the most common presenting symptoms were shortness of breath in 20 patients (90 percent) and chest pain in 7 (32 percent). None had systemic embolic episodes. ECG showed left bundle-branch block in 13 (59 percent) and left ventricular hypertrophy in 14 (63 percent), QS pattern in 5 (23 percent) and 1 patient was in atrial fibrillation. Echocardiographically all had a dilated left ventricle with increased end-systolic and end-diastolic diameter, 55.7 + 9.2 and 66.1+9.2, respectively, and reduced fractional diameter shortening, 11.5 +4.7 percent. The mean cardiac index was 2.1 l/m 2 /min + 0.67 and ejection fraction was 22 + 6.5 percent. Mild to moderate mitral regurgitation was present in 12 patients (54 percent). Following conventional medical therapy, 2 of the 11 patients who were available for follow-up showed symptomatic improvement; the remaining 9 had no or only slight improvement. The pattern of symptoms and clinical findings were similar to that reported in Westerners, suggesting that the natural history of congestive cardiomyopathy in Saudi patients will also be similar with a probable low incidence of embolic phenomena.MA Halim, ME Fawzy, GM Ziady, R Guindy, J Heibig and N Feteih, Dilated Congestive Cardiomyopathy in Saudi Patients. 1983; 3(4): 227-230

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