Endomyocardial Fibrosis Associated With Myocardial Infarction

Endomyocardial fibrosis (EMF) is the most common cause of restrictive cardiomyopathy in Africa and South America. We present a case of a 55-year-old man who experienced an anterior myocardial infarction due to thrombotic occlusion of the left anterior descending artery. Multimodality imaging revealed left ventricular (LV) apical obliteration, apical thrombus, and subendocardial fibrosis, without significant systolic dysfunction, consistent with EMF. EMF should be suspected in patients presenting with heart failure symptoms because of restrictive physiology and/or thrombotic manifestations with typical echocardiographic findings. Cardiac magnetic resonance imaging can provide valuable information regarding typical scar patterns. Similar features can be observed in other forms of cardiopathy, including apical hypertrophic cardiomyopathy, LV thrombosis, excessive LV trabeculation, and Ebstein anomaly.