Clinical aspects of endomyocardial fibrosis in Bahia, Brazil

The clinical and laboratory findings of 12 patients from Bahia, Brazil, with endomyocardial fibrosis are presented. All the patients were from the poor socioeconomic group. Eight patients who died had necropsy confirmation. The disease may present in an acute and chronic form. The clinical picture of venous hypertension, refractory ascites, and peripheral edema was common to all patients at some stage. Chronic pericardial effusion was present in three cases. In 9 patients, the low QRS voltage in V 1 contrasted with the normal voltage of V 2. The chest film of 11 patients showed prominent bulge of the right cardiac border. A restrictive pattern was present in the right atrial pressure curve of 4 patients, and in the right ventricular pressure curve of 2. The main angiocardiographic findings were pericardial effusion and an enlarged right atrium. The differential diagnosis in this area includes Chagas' myocarditis, rheumatic heart disease, and hepatic and pulmonary schistosomiasis. It is hoped that this clinical presentation will lead to increased recognition of the condition in its early stages.