Acute eosinophilic myocarditis: Diagnosis and treatment

Rezaizadeh, Houman; Sanchez-Ross, Monica; Kaluski, Edo; Klapholz, Marc; Haider, Bunyad; Gerula, Christine

doi:10.3109/17482940903578998

Cited by 40 publications

(52 citation statements)

References 32 publications

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“…549 Eosinophilic myocarditis is the primary manifestation of the disease only 5% of the time but remains the number one cause of morbidity and mortality because of its often dramatic presentation and rapidly progressive course. 549,551 Eosinophilic myocarditis progresses in 3 stages (necrotic, thrombotic, and fibrotic). The initial necrotic stage is characterized by myocardial necrosis and is often subclinical but can present as fulminant myocarditis.…”

Section: Pathophysiology/clinical Presentationmentioning

confidence: 99%

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Bozkurt¹,

Colvin²,

Cook³

et al. 2016

Circulation

624

663

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CLINICAL STATEMENTS AND GUIDELINEST he intent of this American Heart Association (AHA) scientific statement is to summarize our current understanding of dilated cardiomyopathies. There is special emphasis on recent developments in diagnostic approaches and therapies for specific cardiomyopathies. Recommendations in this document are based on published studies, published practice guidelines from the American College of Cardiology (ACC)/AHA 1 and other organizations, 2,3 and the multidisciplinary expertise of the writing group. Existing evidence in epidemiology, classification, diagnosis, and management of specific cardiomyopathies is usually derived from nonrandomized observational studies, registries, case reports, or expert opinion based on clinical experience, not large-scale randomized clinical trials or systematic reviews. Therefore, in this document, rather than using the standard ACC/AHA classification schema of recommendations and level of evidence, 4 we have included key management strategies at the end of each section and categorized our recommendations according to the level of consensus. Although the format of our recommendations might resemble the ACC/AHA classification of recommendations used in the ACC/AHA practice guidelines, because of the preponderance of expert opinion or level of evidence C evidence in our document, we elected to use different terminology to provide a distinction from the practice guidelines, in which stronger levels and quality of evidence with randomized clinical trials or meta-analyses are usually present. 4 The levels of evidence follow the AHA and ACC methods of classifying the level of certainty of the treatment effect. 4 DEfINITIoN of DILATED CArDIoMyopAThyThe term dilated cardiomyopathy (DCM) refers to a spectrum of heterogeneous myocardial disorders that are characterized by ventricular dilation and depressed myocardial performance in the absence of hypertension, valvular, congenital, or ischemic heart disease. 5 In clinical practice, the pathogenesis of heart failure (HF) has often been placed into 2 categories: ischemic and nonischemic cardiomyopathy. The term nonischemic cardiomyopathy has been interchangeably used with DCM. Although this approach might be practical, it fails to recognize that nonischemic cardiomyopathy can include cardiomyopathies caused by volume or pressure overload (such as hypertension or valvular heart disease) that are not conventionally accepted under the definition of DCM. 1,5 Again, in general practice and clinical research trials, the term ischemic cardiomyopathy is defined as cardiomyopathy caused by ischemic heart disease. Current use of ischemic cardiomyopathy terminology implies ventricular dilation and depressed myocardial contractility caused by ischemia or infarction. CLASSIfICATIoN of CArDIoMyopAThIESThe first classification on this topic categorized cardiomyopathies as heart muscle diseases with dilated (DCM), hypertrophic, restrictive, arrhythmogenic right ventricular (ARVC), or nonclassifiable cardiomyopathy in 1980. 5 Subse...

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Section: Pathophysiology/clinical Presentationmentioning

confidence: 99%

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Bozkurt¹,

Colvin²,

Cook³

et al. 2016

Circulation

624

663

View full text Add to dashboard Cite

show abstract

“…Despite the need to establish a histological diagnosis, prompt initiation of corticosteroid therapy is mandatory since any delay increases the risk of significant restrictive heart failure [6] . As reported in several cases [3,6,7] , CMRI has an emerging important role in the non-invasive diagnosis of cardiac involvement in HES. Delayed-enhancement gadolinium imaging is typically seen in these cases, revealing myocardial inflammation and fibrosis, with high sensitivity in all stages of endomyocardial damage [6] .…”

Section: Case Reportmentioning

confidence: 99%

“…Cardiac involvement most frequently presents as heart failure, intracardiac thrombus, myocardial ischaemia, arrhythmias or pericarditis [2] . There are some reported cases of eosinophilic myocarditis clinically presenting as ACS [5][6][7] . The clinical manifestations mimicking an ACS may be related to coronary artery spasm, coronary aneurysms, occlusive coronary thrombi or coronary artery dissection [7] .…”

Section: Case Reportmentioning

confidence: 99%

“…There are some reported cases of eosinophilic myocarditis clinically presenting as ACS [5][6][7] . The clinical manifestations mimicking an ACS may be related to coronary artery spasm, coronary aneurysms, occlusive coronary thrombi or coronary artery dissection [7] . EKG frequently shows T-wave inversion and ST-T wave abnormalities, probably due to endomyocardial fibrosis and inflammation [3] .…”

Section: Case Reportmentioning

confidence: 99%

“…The management of HES includes conventional therapy for heart failure and immunosuppressive therapy for the underlying eosinophilia. Several cases have shown good outcomes with prednisolone prescribed at a starting dose of 1 mg/kg/day (as used in conventional heart failure therapy), with improvement of symptoms, increased ejection fraction and resolution of eosinophilia [6,7] . In line with other reported cases, our patient had a good response with prednisolone 1 mg/kg/day, with recovery of ejection fraction.…”

Section: Case Reportmentioning

confidence: 99%

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Hypereosinophilic Syndrome Simulating an Acute Coronary Syndrome

Neves

Ferreira

Franco

et al. 2015

European Journal of Case Reports in Internal Medicine

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Objectives:To report a case of hypereosinophilic syndrome which presented clinically as acute coronary syndrome. Materials and methods:We describe the case of a 69-year-old woman with acute coronary syndrome and peripheral hypereosinophilia. Results: The condition rapidly evolved to severe heart failure. Coronary disease was excluded by cardiac catheterization. Systemic corticosteroid therapy was initiated and further secondary causes of hypereosinophilia were excluded.

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Eosinophilia and the Hypereosinophilic Syndrome

Hsieh

2015

Encyclopedia of Life Sciences

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The eosinophilic granulocyte is involved in the pathogenesis of diverse inflammatory processes, some of which may be beneficial to the host, such as in host defence against parasitic infection, and others are implicated in disease. In addition to being associated with allergic and atopic disease, eosinophilia can be seen in multiorgan system disorders, such as with rheumatologic and hematologic diseases, and can also be associated with single‐organ system disease involving the lungs, the heart, skin and soft tissues, and the gastrointestinal tract. Hypereosinophilia is characterised by the prolonged elevation of the peripheral blood eosinophil count, and the hypereosinophilic syndrome (HES) refers to a group of disorders marked by hypereosinophilia with multisystem target organ damage. The molecular pathogenesis of selected clonal and secondary HESs has been identified, and recognition of specific molecular defects can help to guide specific treatment approaches. Key Concepts The eosinophil is a myeloid lineage granulocyte derived from the hematopoietic stem cell. Interleukin‐5 is the key cytokine involved with eosinophil lineage commitment, development, expansion, homing and activation. Eosinophils produce a diverse array of mediators but there are at least four specific mediators unique to eosinophils – eosinophil cationic protein, eosinophil‐derived neurotoxin, eosinophil peroxidase and major basic protein. A vast array of human diseases is associated with eosinophilia, including single‐organ system involvement and multisystem involvement. The hypereosinophilic syndrome (HES) is defined by having a peripheral blood eosinophilia >1500 cell/μL for at least 1 month, with evidence of eosinophil‐dependent target organ damage, and all other aetiologies of eosinophilia excluded. The myeloproliferative variant HES is characterised by abnormal PDGFRA signalling and is markedly sensitive to tyrosine kinase inhibitors targeting PDGFRA. The lymphocytic variant HES is a reactive eosinophilia driven by clonal, nonmalignant T cells with abnormal immunophenotype secreting high concentrations of eosinophilpoietins such as IL‐5.

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Acute eosinophilic myocarditis: Diagnosis and treatment

Cited by 40 publications

References 32 publications

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Hypereosinophilic Syndrome Simulating an Acute Coronary Syndrome

Eosinophilia and the Hypereosinophilic Syndrome

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