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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.<ref>{{Cite journal
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.<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
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  | doi = 10.1016/j.amjms.2017.04.002
  | doi = 10.1016/j.amjms.2017.04.002
  | pmid = 29173361
  | pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<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
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>
==Classification==
*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]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
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  | doi = 10.1016/j.iac.2007.07.001
  | doi = 10.1016/j.iac.2007.07.001
  | pmid = 17868859
  | pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<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> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the 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>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* 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>
** Eosinophillic Granulomatosis Polyangitis<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><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 = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <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>
* 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
}}</ref><ref>{{Cite journal
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
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  | pmid = 29538200
  | pmid = 29538200
}}</ref>
}}</ref>
==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<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 = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>
==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
:*Reactive<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]]
Line 277: Line 125:


==Pathophysiology==
==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
*The pathogenesis of eosinophilic cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | 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
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
Line 332: Line 180:
  | doi = 10.1097/MD.0000000000010079
  | doi = 10.1097/MD.0000000000010079
  | pmid = 29538200
  | pmid = 29538200
}}</ref>.
}}</ref>.<ref>{{Cite journal
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <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]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 390: Line 248:
  | pmid = 26486351
  | pmid = 26486351
}}</ref>  
}}</ref>  
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
  | author = [[Gustav Mattsson]] & [[Peter Magnusson]]
  | author = [[Gustav Mattsson]] & [[Peter Magnusson]]
  | title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
  | title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
Line 402: Line 260:
  | pmid = 29262787
  | pmid = 29262787
}}</ref>
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
*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]]
  | 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
  | title = Morphologic spectrum of primary restrictive cardiomyopathy
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==Clinical Features==
==Clinical Features==


* Dyspnea<ref>{{Cite journal
* [[Dyspnea]]<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 428: Line 286:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
* Chest pain<ref>{{Cite journal
* [[Chest pain]]<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 440: Line 298:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
* Cough<ref>{{Cite journal
* [[Cough]]<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 452: Line 310:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
* Embolic events<ref>{{Cite journal
* [[Embolic]] events<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 464: Line 322:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
* Fever <ref>{{Cite journal
* [[Fever]] <ref>{{Cite journal
  | author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
  | author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
  | title = A case of Loeffler's endocarditis after initiation of adalimumab
  | title = A case of Loeffler's endocarditis after initiation of adalimumab
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==Differentiating [disease name] from other Diseases==
==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure, such as:
* Eosinophilic cardiomyopathy must be differentiated from other diseases that cause [[cardiac hypertrophy]], cardiac fibrosis, and [[heart failure]]<ref>{{Cite journal
:* Amyloidosis
| 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]]
:* Sarcoidosis
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
:* Hemachromatosis
| 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 Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
* The prevalence of [[hypereosinophilic syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | 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
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
Line 498: Line 392:


===Age===
===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
*Patients of all age groups may develop ecosinophilic cardiomyopathy.<ref>{{Cite journal
  | author = [[Jason Gotlib]]
  | author = [[Jason Gotlib]]
  | title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
  | title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
Line 537: Line 431:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
* The male to female ratio is approximately 1.47. <ref>{{Cite journal
  | author = [[Jason Gotlib]]
  | author = [[Jason Gotlib]]
  | title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
  | title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
Line 551: Line 445:


===Race===
===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.
*There is no racial predilection for eosinophilic cardiomyopathy.


==Risk Factors==
==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,  
*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
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 569: Line 462:


== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
*Some patients with eosinophilic cardiomyopathy may present asymptomatic.<ref>{{Cite journal
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | 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
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
Line 581: Line 474:
  | pmid = 29538200
  | pmid = 29538200
}}</ref>
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
*Early clinical features include [[dyspnea]], [[fever]], and [[chest pain]].<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 593: Line 486:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
*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]]
  | author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
  | title = Eosinophilic Myocarditis: Clinical Case and Literature Review
  | title = Eosinophilic Myocarditis: Clinical Case and Literature Review
Line 605: Line 511:
  | pmid = 30226920
  | pmid = 30226920
}}</ref>
}}</ref>
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].


== Diagnosis ==
== Diagnosis ==
===Diagnostic Criteria===
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
*The diagnosis of [[hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | 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
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
Line 633: Line 537:
  | pmid = 22460074
  | pmid = 22460074
}}</ref>
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*An elevated [[eosinophil]] count (>1500/mm3) on 2 separate tests (≥1 mo).
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*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
:*Marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to [[hypereosinophilia]].


=== Symptoms ===
=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
* Eosinophilic cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | 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
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
Line 650: Line 554:
  | pmid = 29538200
  | pmid = 29538200
}}</ref>
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
*Symptoms of eosinophilc cardiomypoathy may include the following:<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 661: Line 565:
  | doi = 10.1016/j.iac.2007.07.001
  | doi = 10.1016/j.iac.2007.07.001
  | pmid = 17868859
  | 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>
}}</ref>
:*Fever
** [[Fever]]
:*Dyspnea at rest or on exertion
** [[Dyspnea]] at rest or on exertion
:*Chest pain
** [[Chest pain]]
:*Cough
** [[Cough]]
:*Rash
** [[Rash]]
:*Malaise
** [[Malaise]]


=== Physical Examination ===
=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Patients with eosinophilic cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
*Physical examination may be remarkable for:<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
Line 682: Line 594:
  | doi = 10.1016/j.iac.2007.07.001
  | doi = 10.1016/j.iac.2007.07.001
  | pmid = 17868859
  | 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>
}}</ref>
:*Fever
** [[Fever]]
:*Tachycardia
** [[Tachycardia]]
:*Tachypnea
** [[Tachypnea]]
:*Arrythmia
** [[Arrythmia]]
:*Rash
** [[Rash]]
:*Embolic events
** [[Embolic]] events


=== Laboratory Findings ===
=== Laboratory Findings ===


*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*A positive cardiac [[biopsy]] is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.
| 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===
   
   
*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
*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]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 710: Line 665:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
*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]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 722: Line 677:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
*[[Echocardiography]] may demonstrate:<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 734: Line 689:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
**Endomyocardial thickening
**Ventricular [[thrombus]] formation
**Mitral valve involvement


=== Other Diagnostic Studies ===
=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
*Eosinophilic cardiomyopathy may also be diagnosed using [[ECG]].<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 748: Line 706:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
*Findings on [[ECG]] include:<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 760: Line 718:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
**T wave inversion
**Left atrial enlargement
**[[Left ventricular hypertrophy]]
**[[Right bundle branch block]]


== Treatment ==
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The treatment of eosinophilic cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy is supportive care.  
 
*The mainstay of therapy for eosinophilic cardiomyopathy with a FIP1L1-PDGFRA mutation is [[imatinib]] and [[steroids]].<ref>{{Cite journal
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 779: Line 739:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
*Symptomatic management includes:<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 802: Line 762:
  | pmid = 16160202
  | pmid = 16160202
}}</ref>
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
**[[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]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 814: Line 791:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].


=== 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
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 831: Line 806:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
*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]]
  | 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
  | 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
Line 845: Line 820:


=== 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]]
*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].
| 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>


==References==
==References==

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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