Endomyocardial fibrosis (EMF), the most common restrictive cardiomyopathy worldwide, remains a mysterious disease and has some unique characteristics, namely its geographical clustering and a strong relationship with poverty.1 It affects predominantly children and adolescents, and in endemic areas of Africa is an important cause of heart failure in the young. The aetiology and pathogenesis remain unknown, which explains the lack of effective therapy. Mean survival after the first symptoms is reported to be 24 months but this seems to be improving.2 Most patients reported from hospital series have advanced disease and complications of long-standing heart failure. Death results from heart failure, arrhythmia and/or thrombo-embolism.
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