eMedicine Specialties > Cardiology > Myocardial Disease and Cardiomyopathies

Endomyocardial Fibrosis: Treatment & Medication

Author: James L Furgerson, MD, Consulting Staff, Cardiology Service, Brooke Army Medical Center; Clinical Assistant Professor, Department of Internal Medicine, University of Texas Health Science Center at San Antonio
Contributor Information and Disclosures

Updated: Jan 17, 2006

Treatment

Medical Care

  • In general, the response to medical therapy is poor and unproven.
  • Because most patients with endomyocardial fibrosis (EMF) present long after any possible period of early active myocarditis may have existed, little, if any, role exists for immunosuppressive therapy as is used in some patients with Löffler disease.
  • Symptomatic therapy with diuretics has been shown to be useful, but digoxin, afterload reducers, and beta-blockers have little role in EMF.
  • For patients with severe symptoms, consider surgical therapy because the prognosis for these patients with continued medical therapy alone is dismal.
  • Because the rate of thromboembolism is low among patients with EMF and the patient population affected is not typically compliant with anticoagulation regimens, most authors do not recommend anticoagulant therapy.

Surgical Care

  • Surgical therapy by endocardial decortication seems to be beneficial for many patients with advanced disease who are in functional-therapeutic class III or IV. The operative mortality rate is high (15-20%), but successful surgery has a clear benefit on symptoms and seems to favorably affect survival as well.
  • The most commonly used approach is endocardiectomy, combined with mitral and/or tricuspid repair or replacement (when indicated), using a midline thoracotomy and cardiopulmonary bypass.
    • Depending on the location of the disease (right or left ventricle, apex or inflow tract), a transapical or transventricular approach can be used.
    • Because a well-defined plane of cleavage usually exists between the endocardium and myocardium, endocardiectomy is most frequently feasible.
    • Because the myocardium is not usually affected, the severe hemodynamic derangement associated with EMF is relieved with successful resection of the endocardium.
    • Common postoperative complications include low cardiac output, heart block, and ventricular arrhythmias.

Diet

No specific diet is recommended for this condition.

Activity

No activity restrictions are recommended because activity restrictions have not been proven to alter the prognosis of this condition, and no specific activity has been shown to hasten the onset of fatal arrhythmias or sudden death.

More on Endomyocardial Fibrosis

Overview: Endomyocardial Fibrosis
Differential Diagnoses & Workup: Endomyocardial Fibrosis
Treatment & Medication: Endomyocardial Fibrosis
Follow-up: Endomyocardial Fibrosis
References
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References

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Further Reading

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Keywords

endomyocardial fibrosis, EMF, endomyocardial disease, hypereosinophilic syndrome, obliterative myocardial disease, tropical eosinophilic endomyocardial fibrosis, Davies disease, endocardial fibroelastosis, endomyocardial fibroelastosis, Löffler endocarditis, Loeffler endocarditis, restrictive cardiomyopathy, fibrosis of the endocardial surface of the heart, acute myocarditis, parasites, helminths, protozoans, toxoplasmosis, malaria, eosinophilia, malnutrition, high-tuber diet, cerium toxicity, Ce toxicity, hypomagnesemia, constrictive pericarditis

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Contributor Information and Disclosures

Author

James L Furgerson, MD, Consulting Staff, Cardiology Service, Brooke Army Medical Center; Clinical Assistant Professor, Department of Internal Medicine, University of Texas Health Science Center at San Antonio
James L Furgerson, MD is a member of the following medical societies: American College of Cardiology and American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Hanumant Deshmukh, MD †, Former Chief of Cardiology, Veterans Affairs Medical Center; Former Associate Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Marschall S Runge, MD, PhD, Marion Covington Distinguished Professor of Medicine, Vice Dean for Clinical Affairs, Chairman, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
Marschall S Runge, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Southern Society for Clinical Investigation, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Michael E Zevitz, MD, Assistant Professor of Medicine, Finch University of the Health Sciences, The Chicago Medical School; Consulting Staff, Private Practice
Michael E Zevitz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

 
 
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