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Loefflers Endocarditis

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carol dzorani

This document discusses Loeffler's endocarditis, which is a restrictive cardiomyopathy caused by eosinophilic infiltration of the heart. It has three stages - necrotic, thrombotic, and fibrotic. Symptoms depend on the stage and include fever, weight loss, cough, chest pain, and heart failure. Causes include hypersensitivity reactions, parasites, malignancies, and idiopathic factors. Diagnosis involves blood tests showing eosinophilia and endomyocardial biopsy demonstrating collagen deposits. Treatment consists of medications to reduce eosinophils and heart failure symptoms and possibly endocardioectomy surgery. Prognosis is generally poor.

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LOEFFLERS EOSINOPHILIC ENDOCARDITIS
DEFINITION Restrictive Cardiomyopathy Eosinophilia ( > 12010甼9/L) Disease of the heart muscle Impaired ventricular filling Diastolic volume is NORMAL or INCREASED Affects ONE or BOTH ventricles
stage of manifestation Pathologic specimens Clinical manifestations Necrotic stage (early stage) Eosinophilic myocarditis Endomyocardial fibrosis Hypereosinophilia: Fever, Sweating, Weight loss, Cough, Rash, Chest pain, Lymphadenopathy, Splenomegaly Acute carditis: Anorexia, Weight loss, cough, Pulmonary infiltrates, Skin and retinal lesion, AV valve regurgitation, Biventricular failure, Polymorphic ventricular tachycardia Thrombotic stage Clinical manifestations of thromboembolism Thrombotic emboli: Cerebral, splenic, renal, and coronary infarction, Splinter hemorrhages Fibrotic stage (late stage) Acute Heart Failure Restrictive myopathy : AV valvular regurgitation, Kussmall sign, elevated jugular venous pressure, pulmonary edema, murmur of mitral regurgitation
ETIOLOGY hypereos inophilia allergies parasitic and protozoal infections malignancy + idiopathic autoimmune diseases
ACCOMPANIED BY: Hyper eosinophilic syndrome Eosinophilic leukemia Carcinoma Lymphoma Drug reactions Parasites
GROSS APPEARANCE OF ENDOCARDIUM Normal heart Dense fibrosis of ventricles and valve movement
PATHOGENESIS Eosinophilic penetration Degranulation of basic proteins Cytotoxic effects inhibiting multiple enzyme Fibrotic thickening of portions of heart Cationic proteins + anionic endothelium Endothelial and myocyte damage Large mural thrombi Impaired anticoagulatio n activity endocardial thrombus
LABORATORY INVESTIGATIONS 1.Complete blood count - eosinophilia 2.Cytogenetics FISH 3.Molecular analysis FIP1L1-PDGFRA fusion gene 4.Percutaneous Endomyocardial Biopsy - collagen
IMAGING 1.ECG 2.ECHOCARDIOGRAPHY 3.CT and MRI
PHARMACOLOGICAL MANAGEMENT Group of drugs Comments Diuretics, Cardiac Glycosides, ACE Inhibitors Heart failure drugs for symptomatic relief Tyrosine Kinase Inhibitors Imanitib inhibits cell proliferation Anti IL5 monoclonal AB Mepolizumab inhibit production/activation/ maturation of eosinophils Antineoplastic and Antimetabolites Hydroxyurea inhibit cell growth and proliferation Corticosteroids Methylprednisolone anti-inflammatory drugs Interferon therapy Interferon alpha 2B
SURGICAL MANAGEMENT Endocardioectomy
FOLLOW UP Complete blood count Echocardiography
DIFFERENTIAL DIAGNOSIS 1. Cardiac Neoplasms 2. Cardiomyopathies PROGNOSIS Poor
CAROL TAFADZWA DZORANI 631D

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