Hypereosinophilic Syndrome: A rare case of Loeffler's endocarditis documented in cardiac MRI
ABSTRACT Cardiac manifestation of Hypereosinophilic Syndrome usually presents as Loeffler's endocarditis; this case of unusual manifestation of Hypereosinophilic Syndrome, however, revealed restrictive left ventricular dysfunction and increased left ventricular wall mass. Both, an endocardiac eosinophilic mass and layers of intraventricular thrombus were demonstrated and followed by echocardiography and MRI under treatment. The current case demonstrates not only the diagnostic potential of magnetic resonance imaging (MRI) to visualize eosinophilic infiltrate and thrombus, but also morphologic changes with treatment by oral anticoagulation and immunosuppression. With 6 months of intense medical treatment cardiac MRI was instrumental to document both the endocardiac mass and improvement of left ventricular function.
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ABSTRACT: In inflammatory dilated cardiomyopathy and myocarditis, there is apart from heart failure and antiarrhythmic therapies no alternative to an etiologically driven specific treatment. Their prerequisites are noninvasive and invasive biomarkers including endomyocardial biopsy and PCR on cardiotropic agents. This review deals with the different etiologies of myocarditis and inflammatory cardiomyopathy including the genetic background, the predisposition for heart failure and inflammation. It analyses the epidemiologic shift in pathogenetic agents in the last 20 years, the role of innate and acquired immunity including the T cell and B cell driven immune responses. On this basis, it summarizes phases and clinical faces of myocarditis. It gives an up-to-date information on current treatment options starting with heart failure and antiarrhythmic therapy. Although inflammation can resolve spontaneously, often specific treatment directed to the causative etiology is required. For fulminant, acute and chronic autoreactive myocarditis immunosuppressive treatment is beneficial; for viral cardiomyopathy and myocarditis, IVIG can resolve inflammation and is as successful as interferon therapy in enteroviral and adenoviral myocarditis. Eradication of parvovirus B19 and HHV6 myocarditis is still a problem by anyone of these treatment options. The potential of stem cell therapy has to be tested in future trials. In perimyocardial disease, a locoregional approach with high local doses and low systemic side effects have been shown highly efficient by intrapericardial treatment of triamcinolonacetate facilitated by pericardioscopy for adequate etiopathogenetic diagnosis.Heart Failure Reviews 12/2012; DOI:10.1007/s10741-012-9362-7 · 3.99 Impact Factor
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2013; 40(3):362-3. · 0.63 Impact Factor
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ABSTRACT: Eosinophilia may be responsible for cardiac injuries of widely varying severity, from acute myocarditis to endomyocardial fibrosis. In this review, we present both the molecular mechanisms that are responsible for these lesions and their clinical and paraclinical aspects. Numerous aetiologies can lead to severe eosinophilia, but these are mainly represented by hypersensitivity reactions, rheumatological diseases and hypereosinophilic syndrome. Because cardiac involvement may be extremely severe, echocardiography should be always performed in the context of eosinophilia and appropriate therapeutics should be started rapidly in order to limit the progression of the disease. Copyright © 2015 Elsevier Masson SAS. All rights reserved.Archives of cardiovascular diseases 04/2015; 108(4). DOI:10.1016/j.acvd.2015.01.006 · 1.66 Impact Factor