In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to HFA Silver & Gold Members, Fellows of the ESC and Young combined Members

Diastolic heart failure - As bad as it gets, before it gets better

Session Poster Session 4

Speaker Sidonia Zarnescu

Event : Heart Failure 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Myocardial Disease – Clinical
  • Session type : Poster Session

Authors : S Albu (Bucharest,RO), A Dumitrache (Brasov,RO), C Ginghina (Bucharest,RO), B Popescu (Bucharest,RO), R Jurcut (Bucharest,RO)

Authors:
S Albu1 , A Dumitrache2 , C Ginghina1 , B Popescu1 , R Jurcut1 , 1Institute of Cardiovascular Diseases Prof. C.C. Iliescu, cardiology - Bucharest - Romania , 2Medlife - Brasov - Romania ,

Citation:

Introduction: We report the case of a 43-year-old patient, known with professional exposure to dust, ex- smoker, who complains of fatigue, exertional dyspnea, night sweats and weight-loss for several months. The physical examination revealed axillary adenopathy and hepatosplenomegaly. His laboratory tests showed hypereosinophilia, trombocytopenia, polyglobulia and raised BNP levels. He was first evaluated by the haematologist and the suspicion of a myeloproliferative disease was raised.

Problem, patient management: His transthoracic echocardiogram revealed a cardiac mass attached to the apical and anterior wall of the left ventricle with a maximum thickness of 19 mm, a restrictive diastolic filling pattern, reduced myocardial velocities – all in favour of intrinsic cardiomyopathy. For a better evaluation, cardiac MRI was performed which showed a biventricular involvement (masses attached to the apical free wall of both ventricles- Image A, subendocardial late gadolinium enhancement of both ventricles), being highly suggestive of hypereosinophilic myocarditis. Different hematological tests in search for a possible etiology were performed (bone marrow biopsy and JAK2, BCR-ABL, PDGFR, c-MPL, CALR mutations), with negative results. A parasitologic panel obtained a positive Toxocara canis IgG result. The diagnosis of  chronic eosinophilic leukemia was established by the haematologist.  His treatment included corticotherapy, hydroxyurea, oral anticoagulation, betablocker and diuretics, which was well tolerated.

Questions, problems, possible differential diagnosis: The mechanism for hypereosinophilia in this case was uncertain at the beginning, with multiple possible causes : myeloproliferative syndrome/neoplastic disease (because of multiple organ involvement, laboratory tests), parasitic disease, allergic disease (previous professional exposure to dust). Also, it was decided to use a vitamin K antagonist, due to the uncertain benefits of novel anticoagulants in this setting.

Conclusions: Loeffler endocarditis is a condition resulting from various eosinophilic diseases, including parasitosis, drug hypersensitivity, systemic vasculitis or idiopathic hypereosinophilic syndromes. 
„True" hypereosinophilic syndrome is considered rare. Sometimes, it proves to be challenging to ascertain the etiology, as it was in this case and it is also of great importance for establishing the prognosis.

Members get more

Join now
  • 1ESC Professional Members – access all resources from general ESC events 
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s resources
  • 3Under 40 or in training - with a Combined Membership, access all resources
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are