The Double ‘V’ sign of endomyocardial fibrosis

A 65-year-old woman presented to the cardiology department with exertional dyspnea and palpitations. Physical examination revealed bilateral jugular vein distension and mild lower-extremity edema. Blood tests indicated high B-type natriuretic peptide levels (777ng/mL). Echocardiography showed myocardial hypertrophy of the apical segments of both ventricles with cavity obliteration and left ventricular dysfunction with diffuse hypokinesia. Cardiovascular magnetic resonance (CMR) was performed to confirm the diagnosis. Cine images revealed biatrial enlargement, biventricular systolic dysfunction, and obliteration of both ventricular apical regions (, [...]