Right sided heart failure secondary to hypereosinophilic cardiomyopathy – clinical manifestation and diagnostic pathway

Abstract

Hypereosinophilic cardiomyopathy is a rare restrictive cardiomyopathy which often presents with left-sided heart failure. We present an interesting case of a 58-year-old male patient with known hypereosinophillic syndrome who had presented with congestive cardiac failure with predominant features of right-sided volume overload. Cardiac magnetic resonance imaging confirmed the diagnosis by demonstrating obliteration of the right ventricular apex and endocardial-delayed gadolinium enhancement at the mid-septal and inferior segment, at both the right ventricular and left ventricular apical region, consistent with fibrosis. He was successfully treated with intravenous diuretics to good effect. This case report demonstrates a rare clinical presentation of right ventricle involvement in hypereosinophilic cardiomyopathy and the current pathway for diagnosis with the favoured emergence of cardiac magnetic resonance imaging. All patients with hypereosinophilic syndrome should be closely monitored for signs of cardiac involvement, as early treatment carries a better prognosis.

Anesthetic Management of a Large Right Ventricular Mass due to Idiopathic Hypereosinophilic Syndrome in a Patient Undergoing Cardiac Surgery, a Case Report

“…Cardiovascular complications of HES constitute a significant source of morbidity and mortality, with heart involvement found in approximately 40%-80% of patients. 4 The process of recurrent cytotoxic damage inflicted on myocardial cells from chronic eosinophilic degranulation likely leads to asymptomatic destruction of vascular beds and subsequent activation of the coagulation cascade, allowing for production of mural thrombi in the cardiac ventricles, ventricular outflow tracts, and sub-valvular areas over weeks to months. [5][6][7] This can progress to fibrosis of the thrombi and symptoms of heart failure requiring intervention.…”