Eosinophilic cardiomyopathy: Difference between revisions

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==Overview==
==Overview==


Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium. Eosinophills enter the tissue and undergo degranulation, releasing cytotoxic proteins, increasing production of reactive oxygen species, enzymes, growth factor, and cytokines. This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy.
Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]]. It is a feature of [[hypereosinophilic syndrome]] and occurs in 40-50% of all cases.  Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines. This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the eosinophilic cardiomyopathy: Stage 1 that is acute necrotic stage, stage 2 that is mural [[thrombus]] formation, and stage 3 that is ibrotic stage. There are many causes of [[hypereosinophilic syndrome]] (HES) with eosinophilic cardiomyopathy, these can be classified as reactive, conal myeloid disorder, and idiopathic hypereosinophillic syndrome.
 
==Historical Perspective==
==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936.<ref>{{Cite journal
  | author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
  | author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
  | title = Eosinophilic Myocarditis
  | title = Eosinophilic Myocarditis
Line 30: Line 30:
}}</ref>
}}</ref>


*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
==Classification==
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>


==Classification==
*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
:*[group1]
:*[group2]
:*[group3]
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
==Pathophysiology==
==Pathophysiology==
*The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
*The pathogenesis of eosinophilic cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
*The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref>
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>
 
==Clinical Features==


==Clinical Features==   
* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
  | year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>


==Differentiating [disease name] from other Diseases==
==Differentiating [disease name] from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
* Eosinophilic cardiomyopathy must be differentiated from other diseases that cause [[cardiac hypertrophy]], cardiac fibrosis, and [[heart failure]]<ref>{{Cite journal
:*[Differential dx1]
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
:*[Differential dx2]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
:*[Differential dx3]
| journal = [[European journal of heart failure]]
   
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
  | title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>
 
==Epidemiology and Demographics==
==Epidemiology and Demographics==
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
* The prevalence of [[hypereosinophilic syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
   
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
  | pmid = 29538200
}}</ref>
 
===Age===
===Age===
*Patients of all age groups may develop [disease name].
*Patients of all age groups may develop ecosinophilic cardiomyopathy.<ref>{{Cite journal
   
| author = [[Jason Gotlib]]
*[Disease name] is more commonly observed among patients aged [age range] years old.
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
*[Disease name] is more commonly observed among [elderly patients/young patients/children].
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
  | pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
   
   
===Gender===
===Gender===
*[Disease name] affects men and women equally.
*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
   
   
* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The male to female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
===Race===
===Race===
*There is no racial predilection for [disease name].
*There is no racial predilection for eosinophilic cardiomyopathy.
*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].


==Risk Factors==
==Risk Factors==
*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
*Common risk factors in the development of eosinophilic cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>


== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*The majority of patients with [disease name] remain asymptomatic for [duration/years].  
*Some patients with eosinophilic cardiomyopathy may present asymptomatic.<ref>{{Cite journal
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
| journal = [[Medicine]]
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include [[dyspnea]], [[fever]], and [[chest pain]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with eosinophilic cardiomyopathy may progress to develop [[heart failure]], [[arrythmias]], and [[sudden cardiac death]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>
 
*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>


== Diagnosis ==
== Diagnosis ==
===Diagnostic Criteria===
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
*The diagnosis of [[hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
:*[criterion 1]
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
:*[criterion 2]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
:*[criterion 3]
| journal = [[Medicine]]
:*[criterion 4]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*An elevated [[eosinophil]] count (>1500/mm3) on 2 separate tests (≥1 mo).
:*Tissue hypereosinophilia based on >20% eosinophils in a [[bone marrow]] section.
:*Marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to [[hypereosinophilia]].
 
=== Symptoms ===
=== Symptoms ===
*[Disease name] is usually asymptomatic.
* Eosinophilic cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
*Symptoms of [disease name] may include the following:
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
:*[symptom 1]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
:*[symptom 2]
| journal = [[Medicine]]
:*[symptom 3]
| volume = 97
:*[symptom 4]
| issue = 11
:*[symptom 5]
| pages = e0079
:*[symptom 6]
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of eosinophilc cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
** [[Fever]]
** [[Dyspnea]] at rest or on exertion
** [[Chest pain]]
** [[Cough]]
** [[Rash]]
** [[Malaise]]
 
=== Physical Examination ===
=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Patients with eosinophilic cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:
*Physical examination may be remarkable for:<ref>{{Cite journal
:*[finding 1]
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
:*[finding 2]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
:*[finding 3]
| journal = [[Immunology and allergy clinics of North America]]
:*[finding 4]
| volume = 27
:*[finding 5]
| issue = 3
:*[finding 6]
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref><ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
** [[Fever]]
** [[Tachycardia]]
** [[Tachypnea]]
** [[Arrythmia]]
** [[Rash]]
** [[Embolic]] events


=== Laboratory Findings ===
=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].


*A  [positive/negative] [test name] is diagnostic of [disease name].
*A positive cardiac [[biopsy]] is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
| title = Cardiovascular manifestations of hypereosinophilic syndromes
   
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of [[eosinophils]] in [[peripheral blood smear]] is diagnostic of [[hypereosinophilic syndrome]].<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of eosinophilic cardiomyopathy include:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
  | pmid = 17868859
}}</ref>
**Abnormal [[bone marrow biopsy]]
**Abnormal [[troponins]]
 
===Imaging Findings===
===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].
*[Imaging study 1] is the imaging modality of choice for [disease name].
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
   
   
*Cardiac [[MRI]] is the imaging diagnostic study of choice for eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On cardiac [[MRI]], eosinophilic cardiomyopathy is characterized by hyper-enhancement and thrombus formation.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*[[Echocardiography]] may demonstrate:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
**Endomyocardial thickening
**Ventricular [[thrombus]] formation
**Mitral valve involvement
=== Other Diagnostic Studies ===
=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Eosinophilic cardiomyopathy may also be diagnosed using [[ECG]].<ref>{{Cite journal
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on [[ECG]] include:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
**T wave inversion
**Left atrial enlargement
**[[Left ventricular hypertrophy]]
**[[Right bundle branch block]]


== Treatment ==
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*The treatment of eosinophilic cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.  
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*The mainstay of therapy for eosinophilic cardiomyopathy with a FIP1L1-PDGFRA mutation is [[imatinib]] and [[steroids]].<ref>{{Cite journal
*[Medical therapy 1] acts by [mechanism of action 1].
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
| title = Cardiovascular manifestations of hypereosinophilic syndromes
   
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
**[[Diuretics]]
**[[Beta Blockers]]
**[[ACE inhibitors]]
**[[Angiotensin Receptor Blockers]]
**[[Digoxin]]
*[[Imatinib]] acts by inhibition of [[tyrosine kinase]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with [[Echocardiography]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
  | pmid = 17868859
}}</ref>
 
=== Surgery ===
=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
 
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[[Valve replacement]] may be performed for patients with valvular damage in eosinophilic cardiomyopathy.<ref>{{Cite journal
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
   
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac [[transplant]] may be performed for patients with irreversible damage in eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
  | doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
 
=== Prevention ===
=== Prevention ===
*There are no primary preventive measures available for [disease name].
*There are no primary preventive measures available for eosinophilic cardiomyopathy.
   
   
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
*Once diagnosed and successfully treated, patients with eosinophilic cardiomyopathy are followed-up. Follow-up testing includes [[Echocardiography]] and [[Electrocardiogram]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>


*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 19:22, 21 May 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium. It is a feature of hypereosinophilic syndrome and occurs in 40-50% of all cases. Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines. This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the eosinophilic cardiomyopathy: Stage 1 that is acute necrotic stage, stage 2 that is mural thrombus formation, and stage 3 that is ibrotic stage. There are many causes of hypereosinophilic syndrome (HES) with eosinophilic cardiomyopathy, these can be classified as reactive, conal myeloid disorder, and idiopathic hypereosinophillic syndrome.

Historical Perspective

  • Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936.[1] [2]

Classification

  • Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:[3][4]

Pathophysiology

  • The pathogenesis of eosinophilic cadiomyopathy is characterized by hypereosinophilia [11], thrombi formation [12], restrictive cardiomyopathy[13] [14], and heart failure [15].[16]
  • The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia [17]and hypereosiniophilic syndrome.[18] [19]
  • The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.[20] [21]
  • On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.[22]
  • On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.[23]

Clinical Features

Differentiating [disease name] from other Diseases

Epidemiology and Demographics

Age

  • Patients of all age groups may develop ecosinophilic cardiomyopathy.[34]
  • Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.[35]

Gender

  • Men are more commonly affected with eosinophilic cadiomyopathy than Females.[36]
  • The male to female ratio is approximately 1.47. [37]

Race

  • There is no racial predilection for eosinophilic cardiomyopathy.

Risk Factors

Natural History, Complications and Prognosis

  • Prognosis is generally good, and depends on its etiology.[42]

Diagnosis

Diagnostic Criteria

  • An elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo).
  • Tissue hypereosinophilia based on >20% eosinophils in a bone marrow section.
  • Marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia.

Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

  • Cardiac MRI is the imaging diagnostic study of choice for eosinophilic cardiomyopathy.[53]
  • On cardiac MRI, eosinophilic cardiomyopathy is characterized by hyper-enhancement and thrombus formation.[54]
  • Echocardiography may demonstrate:[55]
    • Endomyocardial thickening
    • Ventricular thrombus formation
    • Mitral valve involvement

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

  • Valve replacement may be performed for patients with valvular damage in eosinophilic cardiomyopathy.[63]
  • Cardiac transplant may be performed for patients with irreversible damage in eosinophilic cardiomyopathy.[64]

Prevention

  • There are no primary preventive measures available for eosinophilic cardiomyopathy.

References

  1. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  2. ↑ Amit Alam, Shankar Thampi, Shahryar G. Saba & Rita Jermyn (2017). "Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis". Clinical medicine insights. Case reports. 10: 1179547617723643. doi:10.1177/1179547617723643. PMID 28890659.
  3. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  4. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  5. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  6. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  7. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  8. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  9. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  10. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  11. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  12. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  13. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  14. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  15. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  16. ↑ M. Arima & T. Kanoh (1999). "Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP". Heart (British Cardiac Society). 81 (6): 669–671. PMID 10336931. Unknown parameter |month= ignored (help)
  17. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  18. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  19. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  20. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  21. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  22. ↑ Gustav Mattsson & Peter Magnusson (2017). "Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids". BMC cardiovascular disorders. 17 (1): 299. doi:10.1186/s12872-017-0734-8. PMID 29262787. Unknown parameter |month= ignored (help)
  23. ↑ A. Angelini, V. Calzolari, G. Thiene, G. M. Boffa, M. Valente, L. Daliento, C. Basso, F. Calabrese, R. Razzolini, U. Livi & R. Chioin (1997). "Morphologic spectrum of primary restrictive cardiomyopathy". The American journal of cardiology. 80 (8): 1046–1050. PMID 9352976. Unknown parameter |month= ignored (help)
  24. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  25. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  26. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  27. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  28. ↑ Nooreen Hussain, Preeti Patel, Jonathan Yin, Rachael Davis & Ossama Ikladios (2019). "A case of Loeffler's endocarditis after initiation of adalimumab". Journal of community hospital internal medicine perspectives. 9 (1): 29–32. doi:10.1080/20009666.2018.1562852. PMID 30788072.
  29. ↑ Petar M. Seferovic, Marija Polovina, Johann Bauersachs, Michael Arad, Tuvia Ben Gal, Lars H. Lund, Stephan B. Felix, Eloisa Arbustini, Alida L. P. Caforio, Dimitrios Farmakis, Gerasimos S. Filippatos, Elias Gialafos, Vladimir Kanjuh, Gordana Krljanac, Giuseppe Limongelli, Ales Linhart, Alexander R. Lyon, Ruzica Maksimovic, Davor Milicic, Ivan Milinkovic, Michel Noutsias, Ali Oto, Oztekin Oto, Sinisa U. Pavlovic, Massimo F. Piepoli, Arsen D. Ristic, Giuseppe M. C. Rosano, Hubert Seggewiss, Milika Asanin, Jelena P. Seferovic, Frank Ruschitzka, Jelena Celutkiene, Tiny Jaarsma, Christian Mueller, Brenda Moura, Loreena Hill, Maurizio Volterrani, Yuri Lopatin, Marco Metra, Johannes Backs, Wilfried Mullens, Ovidiu Chioncel, Rudolf de Boer, Stefan Anker, Claudio Rapezzi, Andrew J. S. Coats & Carsten Tschope (2019). "Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology". European journal of heart failure. doi:10.1002/ejhf.1461. PMID 30989768. Unknown parameter |month= ignored (help)
  30. ↑ Adeyemi Adedamola Taiwo, Lavanya Alapati & Assad Movahed (2019). "Cardiac amyloidosis: A case report and review of literature". World journal of clinical cases. 7 (6): 742–752. doi:10.12998/wjcc.v7.i6.742. PMID 30968039. Unknown parameter |month= ignored (help)
  31. ↑ Jian Liang Tan & Sandeep K. Sharma (2018). "Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report". European heart journal. Case reports. 2 (4): yty103. doi:10.1093/ehjcr/yty103. PMID 31020179. Unknown parameter |month= ignored (help)
  32. ↑ Kristen N.. Brown & Rene R.. Diaz (2019). "Restrictive (Infiltrative) Cardiomyopathy". PMID 30725919. Unknown parameter |month= ignored (help)
  33. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  34. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  35. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  36. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  37. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  38. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  39. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  40. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  41. ↑ Paulo Dinis, Rogerio Teixeira, Luis Puga, Carolina Lourenco, Maria Carmo Cachulo & Lino Goncalves (2018). "Eosinophilic Myocarditis: Clinical Case and Literature Review". Arquivos brasileiros de cardiologia. 110 (6): 597–599. doi:10.5935/abc.20180089. PMID 30226920. Unknown parameter |month= ignored (help)
  42. ↑ Paulo Dinis, Rogerio Teixeira, Luis Puga, Carolina Lourenco, Maria Carmo Cachulo & Lino Goncalves (2018). "Eosinophilic Myocarditis: Clinical Case and Literature Review". Arquivos brasileiros de cardiologia. 110 (6): 597–599. doi:10.5935/abc.20180089. PMID 30226920. Unknown parameter |month= ignored (help)
  43. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  44. ↑ Peter Valent, Amy D. Klion, Hans-Peter Horny, Florence Roufosse, Jason Gotlib, Peter F. Weller, Andrzej Hellmann, Georgia Metzgeroth, Kristin M. Leiferman, Michel Arock, Joseph H. Butterfield, Wolfgang R. Sperr, Karl Sotlar, Peter Vandenberghe, Torsten Haferlach, Hans-Uwe Simon, Andreas Reiter & Gerald J. Gleich (2012). "Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes". The Journal of allergy and clinical immunology. 130 (3): 607–612. doi:10.1016/j.jaci.2012.02.019. PMID 22460074. Unknown parameter |month= ignored (help)
  45. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  46. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  47. ↑ Petar M. Seferovic, Marija Polovina, Johann Bauersachs, Michael Arad, Tuvia Ben Gal, Lars H. Lund, Stephan B. Felix, Eloisa Arbustini, Alida L. P. Caforio, Dimitrios Farmakis, Gerasimos S. Filippatos, Elias Gialafos, Vladimir Kanjuh, Gordana Krljanac, Giuseppe Limongelli, Ales Linhart, Alexander R. Lyon, Ruzica Maksimovic, Davor Milicic, Ivan Milinkovic, Michel Noutsias, Ali Oto, Oztekin Oto, Sinisa U. Pavlovic, Massimo F. Piepoli, Arsen D. Ristic, Giuseppe M. C. Rosano, Hubert Seggewiss, Milika Asanin, Jelena P. Seferovic, Frank Ruschitzka, Jelena Celutkiene, Tiny Jaarsma, Christian Mueller, Brenda Moura, Loreena Hill, Maurizio Volterrani, Yuri Lopatin, Marco Metra, Johannes Backs, Wilfried Mullens, Ovidiu Chioncel, Rudolf de Boer, Stefan Anker, Claudio Rapezzi, Andrew J. S. Coats & Carsten Tschope (2019). "Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology". European journal of heart failure. doi:10.1002/ejhf.1461. PMID 30989768. Unknown parameter |month= ignored (help)
  48. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  49. ↑ Petar M. Seferovic, Marija Polovina, Johann Bauersachs, Michael Arad, Tuvia Ben Gal, Lars H. Lund, Stephan B. Felix, Eloisa Arbustini, Alida L. P. Caforio, Dimitrios Farmakis, Gerasimos S. Filippatos, Elias Gialafos, Vladimir Kanjuh, Gordana Krljanac, Giuseppe Limongelli, Ales Linhart, Alexander R. Lyon, Ruzica Maksimovic, Davor Milicic, Ivan Milinkovic, Michel Noutsias, Ali Oto, Oztekin Oto, Sinisa U. Pavlovic, Massimo F. Piepoli, Arsen D. Ristic, Giuseppe M. C. Rosano, Hubert Seggewiss, Milika Asanin, Jelena P. Seferovic, Frank Ruschitzka, Jelena Celutkiene, Tiny Jaarsma, Christian Mueller, Brenda Moura, Loreena Hill, Maurizio Volterrani, Yuri Lopatin, Marco Metra, Johannes Backs, Wilfried Mullens, Ovidiu Chioncel, Rudolf de Boer, Stefan Anker, Claudio Rapezzi, Andrew J. S. Coats & Carsten Tschope (2019). "Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology". European journal of heart failure. doi:10.1002/ejhf.1461. PMID 30989768. Unknown parameter |month= ignored (help)
  50. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  51. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  52. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  53. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  54. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  55. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  56. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  57. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  58. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  59. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  60. ↑ Sharon Ann Hunt, William T. Abraham, Marshall H. Chin, Arthur M. Feldman, Gary S. Francis, Theodore G. Ganiats, Mariell Jessup, Marvin A. Konstam, Donna M. Mancini, Keith Michl, John A. Oates, Peter S. Rahko, Marc A. Silver, Lynne Warner Stevenson, Clyde W. Yancy, Elliott M. Antman, Sidney C. Jr Smith, Cynthia D. Adams, Jeffrey L. Anderson, David P. Faxon, Valentin Fuster, Jonathan L. Halperin, Loren F. Hiratzka, Alice K. Jacobs, Rick Nishimura, Joseph P. Ornato, Richard L. Page & Barbara Riegel (2005). "ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society". Circulation. 112 (12): e154–e235. doi:10.1161/CIRCULATIONAHA.105.167586. PMID 16160202. Unknown parameter |month= ignored (help)
  61. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  62. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  63. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  64. ↑ Sharon Ann Hunt, William T. Abraham, Marshall H. Chin, Arthur M. Feldman, Gary S. Francis, Theodore G. Ganiats, Mariell Jessup, Marvin A. Konstam, Donna M. Mancini, Keith Michl, John A. Oates, Peter S. Rahko, Marc A. Silver, Lynne Warner Stevenson, Clyde W. Yancy, Elliott M. Antman, Sidney C. Jr Smith, Cynthia D. Adams, Jeffrey L. Anderson, David P. Faxon, Valentin Fuster, Jonathan L. Halperin, Loren F. Hiratzka, Alice K. Jacobs, Rick Nishimura, Joseph P. Ornato, Richard L. Page & Barbara Riegel (2005). "ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society". Circulation. 112 (12): e154–e235. doi:10.1161/CIRCULATIONAHA.105.167586. PMID 16160202. Unknown parameter |month= ignored (help)
  65. ↑ Paulo Dinis, Rogerio Teixeira, Luis Puga, Carolina Lourenco, Maria Carmo Cachulo & Lino Goncalves (2018). "Eosinophilic Myocarditis: Clinical Case and Literature Review". Arquivos brasileiros de cardiologia. 110 (6): 597–599. doi:10.5935/abc.20180089. PMID 30226920. Unknown parameter |month= ignored (help)

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