The clinical and angiographicfindings in 5 consecutive patients with congestive cardiacfailure are presented to illustrate the pitfalls in the clinical diagnosis of endomyocardial fibrosis. In one patient the clinical diagnosis was confirmed at angiography while another patient who had angiographic evidence of early right ventricular endomyocardial fibrosis was diagnosed clinically as mitral stenosis. In 2 patients the clinical diagnosis was erroneous, there being no evidence of endomyocardial fibrosis on angiography. The fifth patient, who had angiographic evidence of idiopathic cardiomegaly, was diagnosed clinically as either idiopathic cardiomegaly or advanced left ventricular endomyocardial fibrosis. In tropical countries, where endomyocardial fibrosis, rheumatic heart disease, and idiopathic cardiomegaly are common, accurate clinical diagnosis of endomyocardial fibrosis is often difficult and angiographic studies are essentialfor confirmation. The clinical, pathological, haemodynamic, and corded by an Electronics for Medicine Multiple Channel radiological features of endomyocardial fibrosis are Recorder. A point midway between the plane of the well known (Davies, 1948; Ball, Williams, and patient's sternum and the plane of the catheter table was Davies, 1954; Shillingford and Somers, 1961; taken as the zero pressure baseline. Angiograms were Parry and Abrahams, 1963; World Health Organiza-taken with an Elema-Schonander AOT rapid film tion, 1965; Cockshott, Saric, and Ikeme, 1967; changer. Somers et al., 1968 a, b) but the aetiology is not. Case reports While an accurate bedside diagnosis is sometimes Case 1 possible inadvancedright ventricularorbiventricular A boy of 13 years was first seen in June 1974 with a year's disease (Abrahams, 1962; World Health Organizahistory of exertional dyspnoea, cough, and progressive tion, 1965; Fowler and Somers, 1968), difficulties swelling of the face and abdomen. He had had no may arise in mild to moderate cases where the previous illness. He had bilateral proptosis and was clinical features of mitral or tricuspid regurgitation severely dyspnoeic. His jugular veins were engorged and, may be confused with rheumatic heart disease and though the height of the jugular venous pressure could idiopathic cardiomegaly (congestive cardiomegaly not be assessed accurately, a giant 'v' wave with a steep of obscure origin). We report here the clinical and 'y' descent were discernible. His pulse was of low volume angiographic findings in. consecutive cases of and he had atrial fibrillation with a ventricular rate of aenograpdic fibndgs n 5 consecutive cases Of about 120/min. His blood pressure was 90/60 mmHg endomyocardial fibrosis to show the difficulties that (12.0/ 8.0 kPa) and there was obvious pulsus paradoxus. may frustrate a bedside diagnosis. No murmur was heard but an early 3rd sound was audible at the apex and also at the left sternal edge. His pulmonary closure sound (P2) was not loud. He had Patients and methods bilateral rhonchi but no crepitations in the chest. His The pa ...
