EMF was first reported in equatorial Africa.1–3 We recognized this disease in the Middle East for the first time in 1980.4,9 It has also been recognized in other areas.11–15 In the Middle East and Far East, the disease can mimic and be confused with the more common RVD, cardiomyopathies, and tuberculous CP. The diagnosis is made by echocardiographic examination when obliteration of the apex is noted with varying degrees of regurgitation of the AV valves and confirmed by angiocardiography, which demonstrates obliteration of the apex of one or both ventricles.16 The cause of the disease is not known. Possibly, abnormal eosinophils are involved in the pathogenesis5–8 because frequently, but inconsistently, eosinophilia is found in patients with EMF, and with eosinophilic leukemia, Löffler disease,7–8 and helminthes-associated hypereosinophilia17 (as occurred in two of our patients with hypereosinophilic syndrome and who acquired biventricular EMF and had more progressive course [cases 16 and 21]). We believe that there are similarities and overlaps between Löffler disease and EMF in presentation, peripheral blood eosinophilia, and pathologic changes during acute endocardial eosinophilic infiltration, chronic fibrotic stages, hemodynamics, and mode of treatment with different geographic distribution (EMF occurs mainly in tropical areas, and Löffler disease is found in temperate countries). Perhaps this may be the same disease in different climates. In this article, we report on 21 EMF patients from different parts of Saudi Arabia (n = 17) Egypt (n = 3), and Syria (n = 1) who initially received a different diagnosis prior to their referral to our center. As the disease mainly presents in the tropical zone, unfamiliarity with this disease still exists; in the remaining part of this article, we will draw particular attention to some of the following characteristic and helpful findings favoring EMF diagnosis.