title: A Challenging Differential Diagnosis: Distinguishing between Endomyocardial Fibrosis and Apical Hypertrophic Cardiomyopathy.
abstract: Endomyocardial fibrosis, which is a cause of restrictive cardiomyopathy, is characterized by the deposition of fibrous tissue in the apical region of 1 or both ventricles. The condition not only affects the diastolic dynamics of the ventricles, but also the function of the atrioventricular valves. The disease occurs predominantly in tropical regions worldwide and in sub-Saharan Africa. This condition is not well understood, with varied manifestations, from subclinical presentations to chronic and progressive edematous syndromes. Here, we present the challenging case of a patient with an indeterminate echocardiographic image, suggesting apical hypertrophy, plus severe aortic stenosis and fibrosis of the left ventricular outflow tract. An electrocardiogram revealed symmetrical T-wave inversion, which is a characteristic manifestation of apical hypertrophy. The importance of cardiac imaging examinations such as echocardiography and cardiac magnetic resonance for differentiating between endomyocardial fibrosis and apical hypertrophy is highlighted in this patient's case.
authors.affiliation: Internal Medical Department, Cardiology Center, Medicine School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil.
authors.forename: Cintia Prado
authors.initials: CP
authors.lastname: Maia
authors.affiliation: Internal Medical Department, Cardiology Center, Medicine School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil.
authors.forename: Luís Gustavo
authors.initials: LG
authors.lastname: Gali
authors.affiliation: Internal Medical Department, Cardiology Center, Medicine School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Schmidt
authors.affiliation: Internal Medical Department, Cardiology Center, Medicine School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil.
authors.forename: Oswaldo César
authors.initials: OC
authors.lastname: de Almeida Filho
authors.affiliation: Internal Medicine Department, Image and Medical Physics Center, Medicine School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil.
authors.forename: Marcel Koenigkam
authors.initials: MK
authors.lastname: Santos
authors.affiliation: Internal Medical Department, Cardiology Center, Medicine School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil.
authors.forename: Luciano Albuquerque Lima
authors.initials: LA
authors.lastname: Saraiva
authors.affiliation: Cardiovascular and Thoracic Surgery Group, Surgery Department, Medicine School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil.
authors.forename: Alfredo José
authors.initials: AJ
authors.lastname: Rodrigues
authors.affiliation: Internal Medical Department, Cardiology Center, Medicine School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil.
authors.forename: Benedito Carlos
authors.initials: BC
authors.lastname: Maciel
authors.affiliation: Internal Medical Department, Cardiology Center, Medicine School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil.
authors.forename: Minna Moreira Dias
authors.identifier: http://orcid.org/0000-0002-2526-0656
authors.initials: MM
authors.lastname: Romano
mesh_terms: D057791:Cardiac Imaging Techniques / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging*; D002313:Cardiomyopathy, Restrictive / Q000000981:diagnostic imaging* / Q000209:etiology; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods; D004719:Endomyocardial Fibrosis / Q000150:complications / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged
keywords: cardiac magnetic resonance; echocardiography; endomyocardial fibrosis; restrictive cardiomyopathy