Cardiac manifestation of the hypereosinophilic syndrome: new insights

Abstract

Cardiac manifestation is the major cause of morbidity in patients with hypereosinophilic syndrome (HES). Clinical features range from heart failure to arterial embolism, which are caused by thickening of the endocardium and mural left ventricular thrombosis. Modern magnetic resonance imaging and echocardiography are able to detect fibrosis, eosinophilic infiltrate and thrombi to stage the fibrotic evolution of the disease. Treatment of HES involves standard medication for heart failure, anticoagulant therapy, immunosuppressive therapy and potentially surgical resection. The outcome of HES depends on both the progression of endocardial fibrosis and associated complications and the 5-year mortality is estimated at 30%.

Hypereosinophilic Syndrome Simulating an Acute Coronary Syndrome

“…Chest pain, cough and palpitations have also been reported. 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] .…”

“…Follow-up should be maintained in order to control the eosinophil level and reassess the need to restart immunosuppressive therapy. There is no evidence for the use of anticoagulation therapy for prophylaxis of thrombotic complications [2,3] . CONCLUSION This case report describes a rare, potentially fatal disease; however, early initiation of corticosteroid therapy contributed to the favourable outcome.…”

“…This new wider definition does not require a previous 6-month period of HE, and includes patients with identified aetiologies and those who have not developed signs and symptoms at the time of diagnosis [1] . Cardiac involvement is a major cause of morbidity and mortality, and affects about 50% of patients [2,3] . Clinical manifestations include signs and symptoms of heart failure, intracardiac thrombus, myocardial ischaemia, arrhythmias and, less frequently, pericarditis [2] .…”

“…Cardiac involvement is a major cause of morbidity and mortality, and affects about 50% of patients [2,3] . Clinical manifestations include signs and symptoms of heart failure, intracardiac thrombus, myocardial ischaemia, arrhythmias and, less frequently, pericarditis [2] . The outcome is variable and depends on the progression of endomyocardial fibrosis, with an estimated 5-year mortality of 30% [2] .…”

“…Clinical manifestations include signs and symptoms of heart failure, intracardiac thrombus, myocardial ischaemia, arrhythmias and, less frequently, pericarditis [2] . The outcome is variable and depends on the progression of endomyocardial fibrosis, with an estimated 5-year mortality of 30% [2] . Clinical presentation of HES simulating a non-ST elevation myocardial infarction (NSTEMI) is rare and so HES is not usually suspected in this scenario.…”