Loeffler endocarditis

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Loeffler endocarditis
HEART: An excellent example of Thrombotic Nonbacterial Endocarditis. Gross: Mitral valve
Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
ICD-10 I42.3
ICD-9 421.0
DiseasesDB 4291
eMedicine med/1318 

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]


Loeffler endocarditis, a form of endocarditis, is one of the two forms of hypereosinophilic syndrome. It is a restricive cardiomyopathy characterized eosinophilia and eosinophilic penetration leading to the fibrotic thickening of portions of the heart (similar to that of endomyocardial fibrosis) and commonly has large mural thrombi. Commonly found in temperate climates.

Common symptoms include edema and breathlessness.

It is named for Wilhelm Löffler.[1][2]


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adalimumab [11]

3d echo: [12]

Churg-Strauss [13]

Multiparametric cardiac magnetic resonance imaging (CMR) [14]

imatinib treatment [15]

Overview

Historical Perspective

Loeffler endocarditis was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].

The association between [important risk factor/cause] and Loeffler endocarditis was made in/during [year/event].

In [year], [scientist] was the first to discover the association between [risk factor] and the development of Loeffler endocarditis .

In [year], [gene] mutations were first implicated in the pathogenesis of Loeffler endocarditis .

There have been several outbreaks of Loeffler endocarditis , including -----.

In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose Loeffler endocarditis .

Classification

There is no established system for the classification of Loeffler endocarditis .

OR

Loeffler endocarditis may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].

OR

Loeffler endocarditis may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3]. Loeffler endocarditis may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].

OR

Based on the duration of symptoms, Loeffler endocarditis may be classified as either acute or chronic.

OR

If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].

OR

The staging of [malignancy name] is based on the [staging system].

OR

There is no established system for the staging of [malignancy name].

Pathophysiology

The exact pathogenesis of Loeffler endocarditis is not fully understood.

OR

It is thought that Loeffler endocarditis is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].

OR

[Pathogen name] is usually transmitted via the [transmission route] route to the human host.

OR

Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.

OR


[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].

OR

The progression to Loeffler endocarditis usually involves the [molecular pathway].

OR

The pathophysiology of [disease/malignancy] depends on the histological subtype.

Causes

Disease name] may be caused by [cause1], [cause2], or [cause3].

OR

Common causes of [disease] include [cause1], [cause2], and [cause3].

OR

The most common cause of Loeffler endocarditis is [cause 1]. Less common causes of Loeffler endocarditis include [cause 2], [cause 3], and [cause 4].

OR

The cause of Loeffler endocarditis has not been identified. To review risk factors for the development of Loeffler endocarditis , click here.

Differentiating ((Page name)) from Other Diseases

Loeffler endocarditis must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

Loeffler endocarditis must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Epidemiology and Demographics

The incidence/prevalence of Loeffler endocarditis is approximately [number range] per 100,000 individuals worldwide.

OR

In [year], the incidence/prevalence of Loeffler endocarditis was estimated to be [number range] cases per 100,000 individuals worldwide.

OR

In [year], the incidence of Loeffler endocarditis is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.


Patients of all age groups may develop Loeffler endocarditis .

OR

The incidence of Loeffler endocarditis increases with age; the median age at diagnosis is [#] years.

OR

Loeffler endocarditis commonly affects individuals younger than/older than [number of years] years of age.

OR

[Chronic disease name] is usually first diagnosed among [age group].

OR

[Acute disease name] commonly affects [age group].


There is no racial predilection to Loeffler endocarditis .

OR

Loeffler endocarditis usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop Loeffler endocarditis .


Loeffler endocarditis affects men and women equally.

OR

[Gender 1] are more commonly affected by Loeffler endocarditis than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.


The majority of Loeffler endocarditis cases are reported in [geographical region].

OR

Loeffler endocarditis is a common/rare disease that tends to affect [patient population 1] and [patient population 2].

Risk Factors

There are no established risk factors for Loeffler endocarditis .

OR

The most potent risk factor in the development of Loeffler endocarditis is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of Loeffler endocarditis include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of Loeffler endocarditis may be occupational, environmental, genetic, and viral.

Screening

There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for Loeffler endocarditis is not recommended.

OR

According to the [guideline name], screening for Loeffler endocarditis by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

Natural History, Complications, and Prognosis

If left untreated, [#]% of patients with Loeffler endocarditis may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of Loeffler endocarditis include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with Loeffler endocarditis is approximately [#]%.

Diagnosis

Diagnostic Study of Choice

The diagnosis of Loeffler endocarditis is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of Loeffler endocarditis is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of Loeffler endocarditis is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of Loeffler endocarditis .

History and Symptoms

The majority of patients with Loeffler endocarditis are asymptomatic.

OR

The hallmark of Loeffler endocarditis is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of Loeffler endocarditis . The most common symptoms of Loeffler endocarditis include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of Loeffler endocarditis include [symptom 1], [symptom 2], and [symptom 3].

Physical Examination

Patients with Loeffler endocarditis usually appear [general appearance]. Physical examination of patients with Loeffler endocarditis is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of Loeffler endocarditis include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of Loeffler endocarditis .

OR

The presence of [finding(s)] on physical examination is highly suggestive of Loeffler endocarditis .

Laboratory Findings

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of Loeffler endocarditis .

OR

Laboratory findings consistent with the diagnosis of Loeffler endocarditis include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with Loeffler endocarditis .

OR

Some patients with Loeffler endocarditis may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with Loeffler endocarditis .

Electrocardiogram

There are no ECG findings associated with Loeffler endocarditis .

OR

An ECG may be helpful in the diagnosis of Loeffler endocarditis . Findings on an ECG suggestive of/diagnostic of Loeffler endocarditis include [finding 1], [finding 2], and [finding 3].

X-ray

There are no x-ray findings associated with Loeffler endocarditis .

OR

An x-ray may be helpful in the diagnosis of Loeffler endocarditis . Findings on an x-ray suggestive of/diagnostic of Loeffler endocarditis include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with Loeffler endocarditis . However, an x-ray may be helpful in the diagnosis of complications of Loeffler endocarditis , which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with Loeffler endocarditis .

OR

Echocardiography/ultrasound may be helpful in the diagnosis of Loeffler endocarditis . Findings on an echocardiography/ultrasound suggestive of/diagnostic of Loeffler endocarditis include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with Loeffler endocarditis . However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of Loeffler endocarditis , which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with Loeffler endocarditis .

OR

[Location] CT scan may be helpful in the diagnosis of Loeffler endocarditis . Findings on CT scan suggestive of/diagnostic of Loeffler endocarditis include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with Loeffler endocarditis . However, a CT scan may be helpful in the diagnosis of complications of Loeffler endocarditis , which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with Loeffler endocarditis .

OR

[Location] MRI may be helpful in the diagnosis of Loeffler endocarditis . Findings on MRI suggestive of/diagnostic of Loeffler endocarditis include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with Loeffler endocarditis . However, a MRI may be helpful in the diagnosis of complications of Loeffler endocarditis , which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with Loeffler endocarditis .

OR

[Imaging modality] may be helpful in the diagnosis of Loeffler endocarditis . Findings on an [imaging modality] suggestive of/diagnostic of Loeffler endocarditis include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

There are no other diagnostic studies associated with Loeffler endocarditis .

OR

[Diagnostic study] may be helpful in the diagnosis of Loeffler endocarditis . Findings suggestive of/diagnostic of Loeffler endocarditis include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for Loeffler endocarditis include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

There is no treatment for Loeffler endocarditis ; the mainstay of therapy is supportive care.

OR

Supportive therapy for Loeffler endocarditis includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of Loeffler endocarditis are self-limited and require only supportive care.

OR

Loeffler endocarditis is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for Loeffler endocarditis is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop Loeffler endocarditis .

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for Loeffler endocarditis include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for Loeffler endocarditis depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Surgery

Surgical intervention is not recommended for the management of Loeffler endocarditis .

OR

Surgery is not the first-line treatment option for patients with Loeffler endocarditis . Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for Loeffler endocarditis is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Primary Prevention

There are no established measures for the primary prevention of Loeffler endocarditis .

OR

There are no available vaccines against Loeffler endocarditis .

OR

Effective measures for the primary prevention of Loeffler endocarditis include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent Loeffler endocarditis . Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

Secondary Prevention

There are no established measures for the secondary prevention of Loeffler endocarditis .

OR

Effective measures for the secondary prevention of Loeffler endocarditis include [strategy 1], [strategy 2], and [strategy 3].

References

  1. Template:WhoNamedIt
  2. W. Löffler. Endocarditis parietalis fibroplastica mit Bluteosinophilie. Ein eigenartiges Krankheitsbild. Schweizerische medizinische Wochenschrift, Basel, 1936, 66: 817-820.
  3. 3.0 3.1 Alam A, Thampi S, Saba SG, Jermyn R (2017) Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis. Clin Med Insights Case Rep 10 ():1179547617723643. DOI:10.1177/1179547617723643 PMID: 28890659
  4. Benezet-Mazuecos J, de la Fuente A, Marcos-Alberca P, Farre J (2007) Loeffler endocarditis: what have we learned? Am J Hematol 82 (10):861-2. DOI:10.1002/ajh.20957 PMID: 17573694
  5. Gao M, Zhang W, Zhao W, Qin L, Pei F, Zheng Y (2018) Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature. Medicine (Baltimore) 97 (11):e0079. DOI:10.1097/MD.0000000000010079 PMID: 29538200
  6. Kalra DK, Park J, Hemu M, Goldberg A (2019) Loeffler Endocarditis: A Diagnosis Made with Cardiovascular Magnetic Resonance. J Cardiovasc Imaging 27 (1):70-72. DOI:10.4250/jcvi.2019.27.e5 PMID: 30701721
  7. Chao BH, Cline-Parhamovich K, Grizzard JD, Smith TJ (2007) Fatal Loeffler's endocarditis due to hypereosinophilic syndrome. Am J Hematol 82 (10):920-3. DOI:10.1002/ajh.20933 PMID: 17534930
  8. Sen T, Ponde CK, Udwadia ZF (2008) Hypereosinophilic syndrome with isolated Loeffler's endocarditis: complete resolution with corticosteroids. J Postgrad Med 54 (2):135-7. PMID: 18480530
  9. Osovska NY, Kuzminova NV, Knyazkova II (2016) Loeffler endocarditis in young woman - a case report. Pol Merkur Lekarski 41 (245):231-237. PMID: 27883350
  10. Niemeijer ND, van Daele PL, Caliskan K, Oei FB, Loosveld OJ, van der Meer NJ (2012) Löffler endocarditis: a rare cause of acute cardiac failure. J Cardiothorac Surg 7 ():109. DOI:10.1186/1749-8090-7-109 PMID: 23046536
  11. Hussain N, Patel P, Yin J, Davis R, Ikladios O (2019) A case of Loeffler's endocarditis after initiation of adalimumab. J Community Hosp Intern Med Perspect 9 (1):29-32. DOI:10.1080/20009666.2018.1562852 PMID: 30788072
  12. Hernandez CM, Arisha MJ, Ahmad A, Oates E, Nanda NC, Nanda A et al. (2017) Usefulness of three-dimensional echocardiography in the assessment of valvular involvement in Loeffler endocarditis. Echocardiography 34 (7):1050-1056. DOI:10.1111/echo.13575 PMID: 28600838
  13. Seo JS, Song JM, Kim DH, Kang DH, Song JK (2010) A Case of Loeffler's Endocarditis Associated with Churg-Strauss Syndrome. J Cardiovasc Ultrasound 18 (1):21-4. DOI:10.4250/jcu.2010.18.1.21 PMID: 20661332
  14. Gastl M, Behm P, Jacoby C, Kelm M, Bönner F (2017) Multiparametric cardiac magnetic resonance imaging (CMR) for the diagnosis of Loeffler's endocarditis: a case report. BMC Cardiovasc Disord 17 (1):74. DOI:10.1186/s12872-017-0492-7 PMID: 28284183
  15. Rotoli B, Catalano L, Galderisi M, Luciano L, Pollio G, Guerriero A et al. (2004) Rapid reversion of Loeffler's endocarditis by imatinib in early stage clonal hypereosinophilic syndrome. Leuk Lymphoma 45 (12):2503-7. DOI:10.1080/10428190400002293 PMID: 15621768


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