Endomyocardial fibrosis is a rare condition in North America but is prevalent in tropical and subtropical regions of the developing world, where it is often referred to as tropical endomyocardial fibrosis. Marked by fibrous deposits in the endomyocardium of the right and left ventricles, the disease leads to restrictive cardiomyopathy. Endomyocardial fibrosis is endemic in parts of Africa, where it was first reported in the 1940s, and is the etiology of up to 20% of cases of heart failure. Endomyocardial fibrosis is also common in rural regions of Asia and Latin America. Although the precise cause remains unclear, environmental factors and infections are believed to trigger chronic inflammation and fibrosis of the endomyocardium. Because the pathology of endomyocardial fibrosis is similar to eosinophilic cardiomyopathy and hypereosinophilic syndromes, it is sometimes considered part of a broader disease spectrum that includes Löffler endocarditis. The natural history of endomyocardial fibrosis is characterized by an active inflammatory phase, which typically causes nonspecific symptoms, followed by chronic inflammation and fibrous deposits in the heart, eventually resulting in restrictive cardiomyopathy. Clinical manifestations of endomyocardial fibrosis include heart failure, arrhythmias, and systemic thromboembolism. Without treatment, the prognosis of endomyocardial fibrosis is poor.

Tropical endomyocardial fibrosis (TEF) is a rare condition that occurs primarily in tropical countries, leading to a severe heart failure with heart restrictive filling patterns. Eosinophilia appears to be a trigger leading to the development of the disease; thus, numerous etiologic factors accompanied by eosinophilia have been postulated, although none have been confirmed. The massively calcified form of TEF is exceptional and easily diagnosed by multimodal imaging; but it is a very rare condition with high surgical challenge. the best prevention remains the testing and treatment of parasitic infections frequently encountered in these countries.

Tropical endomyocardial fibrosis is a common cause of restrictive cardiomyopathy worldwide, but is relatively rare in developed countries. We present a case of tropical endomyocardial fibrosis with right ventricular involvement initially mistaken as Ebstein's anomaly. We highlight the need for timely and accurate diagnosis to ensure appropriate management. (Level of Difficulty: Intermediate.).

Due to an increase in global mobility, international travel and migration, tropical diseases are more frequently observed in Germany. Some tropical diseases can also affect the heart, cause cardiac symptoms and may require inclusion in differential diagnostic work-ups. The most important tropical diseases with cardiac involvement are Chagas' disease and echinococcosis. Other tropical diseases such as schistosomiasis, tropical endomyocardial fibrosis or sleeping sickness can affect the heart. The suspicion of a tropical disease as the cause of cardiac symptoms is based on the patient history of travel, migration and social setting. This CME article describes the diagnostic and therapeutic approach to tropical parasitic diseases with cardiac involvement.