A case report of atrial flutter and heart failure in patient with Right Ventricular Endomyocardial fibrosis


  • Hanee Mehboob Mohamed Department of Internal Medicine, Cardiology Unit, Aga Khan University Hospital, Dar es salaam




restrictive, cardiomyopathy, warfarin, amiodarone, endocardiectomy, valve replacement.


Endomyocardial fibrosis is a restrictive cardiomyopathy with highest prevalence in Sub-Saharan Africa, usually affecting children and adolescents. The disease usually occurs in a geographical distribution within 15 degrees on either side of equator. Literature shows that most common form is the biventricular endomyocardial fibrosis. This is a report on a 44 years old female patient with recurrent acute heart failure episodes whom diagnosed to have right ventricular endomyocardial fibrosis on Echocardiogram. Her electrocardiogram showed atrial flutter with variable blocks. Currently, she is attending out-patient cardiology clinic and her medications include tablets amiodarone 200mg daiy, warfarin 5mg daily, aldactone 25mg daily, bisoprolol 2.5mg daily and telmisartan 40mg daily. Her International Normalized Ratio (INR) is therapeutic. This case involves the presence of atrial flutter in a patient with right ventricular endomyocardial fibrosis that has not been reported. Also, emphasizes the burden of endomyocardial fibrosis in our local setting, its diagnosis and management.


Mocumbi AO. Right ventricular endomyocardial fibrosis (2013 Grover Conference series).Pulm Circ. 2014 Sep; 4(3):363-9.

G. Vijayaraghavan and S. Sivasankaran. Tropical endomyocardial fibrosis in India: A vanishing disease! Indian J Med Res. 2012 Nov; 136(5): 729–738.

Connor DH, Somers K, Hutt MSR, Manion WC, D’Arbela PG. Endomyocardial fibrosis in Uganda (Davies’ disease). Part I: An epidemiologic, clinical, and pathologic study. Am Heart J. 1967; 74:687–709.

Connor DH, Somers K, Hutt MS, Manion WC, D’Arbela PG. Endomyocardial fibrosis in Uganda (Davies’ disease). II. An epidemiologic, clinical, and pathologic study. Am Heart J. 1968; 75:107–24.

Mocumbi AO, Yacoub S, Yacoub MH. Neglected tropical cardiomyopathies: II.Endomyocardial fibrosis: myocardial disease. Heart. 2008; 94:384–90.

Hutt MS. Epidemiology aspects of endomyocardial fibrosis. Postgrad Med J. 1983; 59:142–6.

Mocumbi AO, Ferreira MB, Sidi D, Yacoub MH. A population study of endomyocardial fibrosis in a rural area of Mozambique. N Engl J Med. 2008; 359:43–9.

Chelo D, Nguefack F, Mbassi Awa HD, Kingue S. Endomyocardial fibrosis in Sub Saharan Africa: The geographical origin, socioeconomic status, and dietary habits of cases reported in Yaounde, Cameroon.Ann Pediatr Cardiol. 2015 Sep-Dec; 8(3):202-9.

Seth S, Thatai D, Sharma S, Chopra P, Talwar KK. Clinico-pathological evaluation of restrictive cardiomyopathy (endomyocardial fibrosis and idiopathic restrictive cardiomyopathy) in India.Eur J Heart Fail. 2004 Oct; 6(6):723-9.

Mocumbi AO, Carrilho C, Sarathchandra P, Ferreira MB, Yacoub M, Burke M. Echocardiography accurately assesses the pathological abnormalities of chronic endomyocardial fibrosis.Int J Cardiovasc Imaging. 2011 Oct; 27(7):955-64.

Muthiah, R. (2016) Endomyocardial Fibrosis: Echocardiographic Profile. Case Reports in Clinical Medicine, 5, 180-187.

Cuisset T, Nait Saidi L, Mouret JP, Barbou F, Quilici J, Fourcade L, Lambert M, Ghez O,Metras D, Bonnet JL. [Endomyocardial fibrosis: a rare case of restrictive cardiomyopathy in a Caucasian female]. Arch Mal Coeur Vaiss. 2006 Jan; 99(1):73-6.

Muthukumar L., Jan M. F., Whitnah J., and Tajik A. J. (2016) Coexistence of apical hypertrophic cardiomyopathy and endomyocardial fibrosis with calcification: diagnosis using multimodality imaging. ESC Heart Failure, 3: 278–281.

Deepak Madi, Basavaprabhu Achappa, Narasimha Pai, andPadmanabha Kamath. Right ventricular endomyocardial fibrosis – A case report. Australas Med J. 2013; 6(2): 88–90.

Santra G, Sinha PK, Phaujdar S, De D. Right ventricular endomyocardial fibrosis. J Assoc Physicians India. 2012 Mar; 60:63-5.

Barretto AC, Mady C, Nussbacher A, Ianni BM, Oliveira SA, Jatene A, Ramires JA. Atrial fibrillation in endomyocardial fibrosis is a marker of worse prognosis. Int J Cardiol. 1998 Nov 30; 67(1):19-25.

Somers K, Gunstone RF, Patel AK, D`Arbela PG. Atrial arrhythmias in Endomyocardial fibrosis. Cardiology 1972; 57:369-373.

Grimaldi A, Mocumbi AO, Freers J, Lachaud M, Mirabel M, Ferreira B, Narayanan K, Celermajer DS, Sidi D, Jouven X, Marijon E. Tropical Endomyocardial Fibrosis: Natural History, Challenges, and Perspectives. Circulation. 2016 Jun 14; 133(24):2503-15.




How to Cite

Mohamed, H. M. (2017). A case report of atrial flutter and heart failure in patient with Right Ventricular Endomyocardial fibrosis. Tanzania Medical Journal, 29(1), 74–84. https://doi.org/10.4314/tmj.v29i1.273



Case Reports

Most read articles by the same author(s)