[Cardiac findings in bilharziasis without pulmonary arterial hypertension]

1. A systematic search was made for cardiac abnormalities (clinical, radiological and ECG) and haemodynamic disorders (catheterisation of the right side of the heart and pulmonary artery) in 37 cases of confirmed biharziasis. It was generally found that:--14 patients (37.8%) had no symptoms;--8 patients (21.6%) had pulmonary hypertension (PH) with the corresponding cardiac signs (these will be reported separately);--15 patients (40.5%) had cardiac signs with no PH; these are studied in this paper. 2. Iatrogenic myocarditis was noted on the ECG. It was found in 3 of the 37 cases (8.1%). This points to the importance of careful monitoring of treatment. There was also ECG evidence of anaemyic myocardial changes in 5 cases of the 37 (13.5%). In 3 of these 5 cases this was found to be due to bleeding. Hypertensive myocardial disease was found in 1 case (2.7%), a patient with renal disease. Myocardial signs were also found in 3 cases because of coexistant disease. 3. Three cases (8.1%) remain in whom there were ECG changes, but without PH and without any other definable cause. These could have been due to bilharzia myocarditis; the authors review the experimental and clinical evidence for such a possibility. The real incidence of this condition remains to be determined. 4. Although there was no such case in this series, the authors suggest that bilharziasis might cause endomyocardial fibrosis (EMCF). 5. The authors put forward the hypothesis that the pulmonary arteritis is a tissue immunological reaction, and also that the myocarditis (and possibly the EMCF) is a manifestation of circulating antibodies.