CLINICAL AND HÆMODYNAMIC PATTERNS IN ENDOMYOCARDIAL FIBROSIS

In recent years endomyocardial fibrosis has attracted increasing attention as an important cause of heart disease in the equatorial parts ofAfrica. Bedford and Konstam (1946) described the disease in West and East African troops; Davies in 1948 documented the pathology of the condition, and Ball et al. (1954) drew attention to the frequency of its occurrence and described in detail the clinical picture. Subsequently the workers at Kampala have reported the electrocardiographic and phonocardiographic findings (Williams and Somers, 1960; Somers and Williams, 1960). Other cases have been reported in the Sudan (O'Brien, 1954); on the Gold Coast (Edington, 1954); in Ceylon (Nagaratnam and Dissanayake, 1959); in Kenya (Turner and Manson-Bahr, 1960), and in West Africa (Abrahams, 1959). The purpose of this paper is to describe the haemodynamic findings in a series of patients with endomyocardial fibrosis and relate these to the clinical findings. Fifteen patients were studied and the diagnosis made on clinical grounds. The ages ranged from eleven to fifty-five, seven were male and eight female. A clinical examination was made and an electrocardiogram and chest X-ray taken in all cases. Cardiac catheterization was carried out and the intracardiac pressures recorded by a Statham strain gauge connected to a transistor amplifier and photographic recorder. All measurements of pressure were made 5 cm. below the sternal angle. In selected cases phonocardiograms were taken with a photographic recorder. The circulation time from the right atrium to the ear was measured by injecting Coomassie-blue dye into the right atrium and recording its arrival at the ear with a photoelectric cell attached to the transilluminated ear (Gabe and Shillingford, 1961).