wikidoc - User contributions [en]

Congenital heart block

2019-09-09T19:34:27Z

Archana Murugan: /* Prevention */

__NOTOC__
{{SI}}

'''For patient information page click [[{{PAGENAME}} (patient information)|here]]'''

{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; '''Contributors:''' [[User:Lakeadam|Adam C. Lake]]

==Overview==
Congenital heart block is a rare [[congenital heart disease]] caused by defects in the heart conduction system diagnosed on or before 28 days of life.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
It can lead to [[bradycardia|slowed heart rate]].

==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

==Classification==
*Congenital Heart Block may be classified according to cause into 3 subtypes/groups:
:*Autoimmune
:*Structural
:*Other
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

==Pathophysiology==
Scarring of the conduction system (the heart’s own natural pacemaker), a consequence of [[inflammation]] triggered by the mother’s antibodies, damages or even destroys the cells that allow the heart to beat at a normal rhythm.

[[Neonatal lupus]] (NL) is the name given to a group of conditions that can affect the babies of mothers who have certain [[autoantibody|autoantibodies]] against components of the body’s cells that are called SSA/Ro and SSB/La. Neonatal lupus can appear as a temporary [[rash]] that usually goes away by the time the baby is 6 months old, or very rarely an abnormal blood or [[liver]] condition that also improves with time or it can cause permanent and often life-threatening damage to the fetal heart, known as congenital heart block (CHB). In women with anti-Ro/La antibodies who are pregnant for the first time, only about 2% of the babies will develop congenital heart block. But for a woman who has already had a child with congenital heart block or neonatal lupus rash, the risk of congenital heart block in her next [[pregnancy]] is nearly 20%. Unfortunately, once complete ([[third degree heart block|third degree]]) heart block has been unequivocally identified in a [[fetus]], it has never been reversed with any of the therapies that have been tried to date. If a child is born to a mother with [[lupus]], there is a chance that the child will develop neonatal lupus, especially if the mother is Anti-Ro (SS/A) positive. In the majority of cases, the mother's antibodies will clear from the child in 6 months, however, in a few cases, the affected child will develop complete congenital heart block.

==Causes==
The most common cause of congenital complete heart block is neonatal lupus. It accounts for almost all cases presenting in the intrauterine and neonatal period. Other causes include:
* [[Myocarditis]]
* [[Levo transposition of great arteries]]
* Atrioventricular discordance
* [[Hurler syndrome|Hurler cardiomyopathy]]
* [[Hunter syndrome|Hunter cardiomyopathy]]
* [[Polysplenia]] with atrioventricular canal defect

==Clinical Features==

==Differentiating [disease name] from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:*[Differential dx1]
:*[Differential dx2]
:*[Differential dx3]

==Epidemiology and Demographics==
* The prevalence of congenital heart block is approximately 1 per 22,00 live births individuals worldwide. <ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Pilar Brito-Zeron]], [[Peter M. Izmirly]], [[Manuel Ramos-Casals]], [[Jill P. Buyon]] & [[Munther A. Khamashta]]
| title = The clinical spectrum of autoimmune congenital heart block
| journal = [[Nature reviews. Rheumatology]]
| volume = 11
| issue = 5
| pages = 301–312
| year = 2015
| month = May
| doi = 10.1038/nrrheum.2015.29
| pmid = 25800217
}}</ref>
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

===Age===

*Congential heart block is diagnosed among patients aged from brith to 28 days old.
*Congential heart block is observed among children.

===Gender===
*[Disease name] affects men and women equally.

*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
One form of congenital heart block occurs in babies whose mothers have autoimmune diseases, such as [[SLE|lupus]]. People who have these diseases make proteins called antibodies that attack and damage the body's tissues or cells.

==Natural History, Complications, Prognosis==
===Prognosis===
The damaged heart may beat extremely slowly. In some cases, the heart rate is so slow that it is fatal in nearly 20% of affected babies (with most deaths occurring as [[ fetal demise]]s). Patients presenting as fetuses or at birth have significantly higher morbidity and mortality rates than do patients presenting later in childhood.

*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]

=== Symptoms ===
*Signs and symptoms depend on the type of heart block the child has. [[First-degree heart block]] rarely causes symptoms.
*Symptoms of [[second-degree heart block|second-]] and [[third-degree heart block]] include:
**[[Fainting]]
**[[Dizziness]] or [[light-headedness]]
**[[Fatigue]] ([[tiredness]])
**[[Shortness of breath]]
**[[Chest pain]]

=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*[Imaging study 1] is the imaging modality of choice for [disease name].
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment ==
=== Medical Therapy ===

*The mainstay of [[in utero]] therapy for congenital heart block is [[corticosteroids]].<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Kai-Yu Zhou]] & [[Yi-Min Hua]]
| title = Autoimmune-associated Congenital Heart Block: A New Insight in Fetal Life
| journal = [[Chinese medical journal]]
| volume = 130
| issue = 23
| pages = 2863–2871
| year = 2017
| month = December
| doi = 10.4103/0366-6999.219160
| pmid = 29176145
}}</ref>
*[[Corticosteroids]] act by decreasing [[inflammation]] and damage caused by maternal antibodies.<ref>{{Cite journal
| author = [[Aurelie Ambrosi]] & [[Marie Wahren-Herlenius]]
| title = Congenital heart block: evidence for a pathogenic role of maternal autoantibodies
| journal = [[Arthritis research & therapy]]
| volume = 14
| issue = 2
| pages = 208
| year = 2012
| month = April
| doi = 10.1186/ar3787
| pmid = 22546326
}}</ref>

*Response to [[Corticosteroids]] can be monitored with fetal [[echocardiogram]] every few weeks.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>

=== Surgery ===
*Surgery is the mainstay of therapy for Congenital Heart Block.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
*[[Cardiac pacemaker]] implantation in conjunction with [[Corticosteroids]] is the most common approach to the treatment of Congenital Heart Disease.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Kai-Yu Zhou]] & [[Yi-Min Hua]]
| title = Autoimmune-associated Congenital Heart Block: A New Insight in Fetal Life
| journal = [[Chinese medical journal]]
| volume = 130
| issue = 23
| pages = 2863–2871
| year = 2017
| month = December
| doi = 10.4103/0366-6999.219160
| pmid = 29176145
}}</ref>
*[[Cardiac pacemaker]] implantation can only be performed for patients with [[Mobitz Type II]] and above Congenital Heart Block.<ref>{{Cite journal
| author = [[Kai-Yu Zhou]] & [[Yi-Min Hua]]
| title = Autoimmune-associated Congenital Heart Block: A New Insight in Fetal Life
| journal = [[Chinese medical journal]]
| volume = 130
| issue = 23
| pages = 2863–2871
| year = 2017
| month = December
| doi = 10.4103/0366-6999.219160
| pmid = 29176145
}}</ref>
=== Prevention ===
*There are no primary preventive measures available for Congenital Heart Disease.

*Women of childbearing age with systemic autoimmune disorders should be tested fo anti-Ro and anti-La antibodies.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Pilar Brito-Zeron]], [[Peter M. Izmirly]], [[Manuel Ramos-Casals]], [[Jill P. Buyon]] & [[Munther A. Khamashta]]
| title = The clinical spectrum of autoimmune congenital heart block
| journal = [[Nature reviews. Rheumatology]]
| volume = 11
| issue = 5
| pages = 301–312
| year = 2015
| month = May
| doi = 10.1038/nrrheum.2015.29
| pmid = 25800217
}}</ref>
*Effective measures to decrease the severity of Congenital Heart Block include [[in utero]] administration of [[Corticosteroids]] and [[plasmapheresis]].<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Pilar Brito-Zeron]], [[Peter M. Izmirly]], [[Manuel Ramos-Casals]], [[Jill P. Buyon]] & [[Munther A. Khamashta]]
| title = The clinical spectrum of autoimmune congenital heart block
| journal = [[Nature reviews. Rheumatology]]
| volume = 11
| issue = 5
| pages = 301–312
| year = 2015
| month = May
| doi = 10.1038/nrrheum.2015.29
| pmid = 25800217
}}</ref> <ref>{{Cite journal
| author = [[Kai-Yu Zhou]] & [[Yi-Min Hua]]
| title = Autoimmune-associated Congenital Heart Block: A New Insight in Fetal Life
| journal = [[Chinese medical journal]]
| volume = 130
| issue = 23
| pages = 2863–2871
| year = 2017
| month = December
| doi = 10.4103/0366-6999.219160
| pmid = 29176145
}}</ref>
*Once diagnosed and successfully treated, patients with Congenital Heart Block are followed-up regularly. Follow-up testing includes fetal [[echocardiogram]], [[electcrocardiogram]], and serologic [[antibodies]].<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Pilar Brito-Zeron]], [[Peter M. Izmirly]], [[Manuel Ramos-Casals]], [[Jill P. Buyon]] & [[Munther A. Khamashta]]
| title = The clinical spectrum of autoimmune congenital heart block
| journal = [[Nature reviews. Rheumatology]]
| volume = 11
| issue = 5
| pages = 301–312
| year = 2015
| month = May
| doi = 10.1038/nrrheum.2015.29
| pmid = 25800217
}}</ref>

==References==
{{Reflist|2}}

===Electrocardiogram===
Electrocardiographic findings in congenital heart block depend on the type of block.

==Treatment==
===Surgery===
Treatment depends on the type of heart block.
* [[First-degree heart block]] usually needs no treatment.
* For [[second-degree heart block]], patient may need a [[pacemaker]]. A pacemaker is a small device that's placed under the skin of your chest or [[abdomen]]. This device uses electrical pulses to prompt the heart to beat at a normal rate.
* For [[third-degree heart block]], patient will need a pacemaker.

Nearly all surviving children with congenital heart block require permanent implantation of an [[artificial pacemaker|pacemaker device]].

===Prevention===
Because it is so difficult to treat or repair the damaged heart, a high-priority strategy is to try to prevent the inflammatory process before irreversible scarring can occur. The mother of the child should consult with a rheumatologist to begin monitoring for possible autoimmune disease. Consultation with a rheumatologist is also advised for the infant, particularly if other manifestations of [[neonatal lupus erythematosus]] are present. Genetic consultation is recommended for children with first-degree relatives with structural heart disease or those with storage disorder or [[cardiomyopathy]].

==Source==
* [http://www.clinicaltrials.gov ClinicalTials.gov]

==Related Chapters==
* [[Electrical conduction system of the heart]]
* [[Electrocardiogram]] (ECG or EKG)
* [[SA node]]
* [[AV node]]
* [[Second degree AV block]]
* [[Third degree AV block]]
* [[Bundle branch block]]
* [[Hemiblock]]
* [[Infra-Hisian Block]]
* [[Left anterior fascicular block]]
* [[Left posterior fascicular block]]
* [[Heart block]]
* [[Systemic lupus erythematosus]]
* [[IVIG]]

==References==
{{refbegin|2}}
*Figa FH, McCrindle BW, Bigras JL, et al. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol. Aug 1997;20(8 Pt 1):1902-9.
*Michaelsson M, Jonzon A, Riesenfeld T. Isolated congenital complete atrioventricular block in adult life. A prospective study. Circulation. Aug 1 1995;92(3):442-9. [Full Text].
*Boutjdir M, Chen L, Zhang ZH, et al. Arrhythmogenicity of IgG and anti-52-kD SSA/Ro affinity-purified antibodies from mothers of children with congenital heart block. Circ Res. Mar 1997;80(3):354-62.
*Boutjdir M, Chen L, Zhang ZH, et al. Serum and immunoglobulin G from the mother of a child with congenital heart block induce conduction abnormalities and inhibit L-type calcium channels in a rat heart model. Pediatr Res. Jul 1998;44(1):11-9.
*Claus R, Hickstein H, Kulz T, et al. Identification and management of fetuses at risk for, or affected by, congenital heart block associated with autoantibodies to SSA (Ro), SSB (La), or an HsEg5-like autoantigen. Rheumatol Int. Aug 2006;26(10):886-95.
*Copel JA, Buyon JP, Kleinman CS. Successful in utero therapy of fetal heart block. Am J Obstet Gynecol. Nov 1995;173(5):1384-90.
*Costedoat-Chalumeau N, Amoura Z, Villain E, et al. Anti-SSA/Ro antibodies and the heart: more than complete congenital heart block? A review of electrocardiographic and myocardial abnormalities and of treatment options. Arthritis Res Ther. 2005;7(2):69-73.
*Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, et al. Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. Lupus. 2005;14(9):660-4.
*Cutler NG, Karpawich PP, Cavitt D, et al. Steroid-eluting epicardial pacing electrodes: six year experience of pacing thresholds in a growing pediatric population. Pacing Clin Electrophysiol. Dec 1997;20(12 Pt 1):2943-8.
*Friedman DM, Kim MY, Copel JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation. 2008;117:485-93.
*Friedman DM, Zervoudakis I, Buyon JP. Perinatal monitoring of fetal well-being in the presence of congenital heart block. Am J Perinatol. 1998;15(12):669-73.
*Hamilton R, Gow R, Bahoric B, et al. Steroid-eluting epicardial leads in pediatrics: improved epicardial thresholds in the first year. Pacing Clin Electrophysiol. Nov 1991;14(11 Pt 2):2066-72.
*Hamilton RM, Chiu C, Gow RM, Williams WG. A comparison of two stab-on unipolar epicardial pacing leads in children. Pacing Clin Electrophysiol. Mar 1997;20(3 Pt 1):631-6.
*Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol. Jul 2005;26(1):16-21.
*Karpawich PP, Stokes KB, Proctor K, et al. "In-line" bipolar, steroid-eluting, high impedance, epimyocardial pacing lead. Pacing Clin Electrophysiol. Mar 1998;21(3):503-8.
*Karpawich PP, Walters H, Hakimi M. Chronic performance of a transvenous steroid pacing lead used as an epi- intramyocardial electrode. Pacing Clin Electrophysiol. Jul 1998;21(7):1486-8.
*Miranda-Carus ME, Boutjdir M, Tseng CE. Induction of antibodies reactive with SSA/Ro-SSB/La and development of congenital heart block in a murine model. J Immunol. Dec 1 1998;161(11):5886-92.
*Moak JP, Barron KS, Hougen TJ, et al. Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol. Jan 2001;37(1):238-42.
*Neiman AR, Lee LA, Weston WL, Buyon JP. Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers and children enrolled in a national registry. J Pediatr. Nov 2000;137(5):674-80.
*Rao V, Williams WG, Hamilton RH, et al. Trends in pediatric cardiac pacing. Can J Cardiol. Dec 1995;11(11):993-9.
*Suarez-Penaranda JM, Munoz JI, Rodriguez-Calvo MS, et al. The Pathology of the heart conduction system in congenital heart block. J Clin Forensic Med. Aug-Nov 2006;13(6-8):341-3.
*Weng KP, Chiou CW, Huang SH, et al. The long-term outcome of children with isolated congenital complete atrioventricular block. Acta Paediatr Taiwan. Sep-Oct 2005;46(5):260-7.
{{refend}}

{{Congenital malformations and deformations of circulatory system}}
{{Electrocardiography}}
{{Circulatory system pathology}}
[[Category:Cardiology]]
[[Category:Rheumatology]]
[[Category:Disease]]
[[Category:Congenital disorders]]
[[Category:Developmental biology]]
{{WH}}
{{WS}}

Congenital heart block

2019-09-09T19:10:46Z

Archana Murugan: /* Medical Therapy */

__NOTOC__
{{SI}}

'''For patient information page click [[{{PAGENAME}} (patient information)|here]]'''

{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; '''Contributors:''' [[User:Lakeadam|Adam C. Lake]]

==Overview==
Congenital heart block is a rare [[congenital heart disease]] caused by defects in the heart conduction system diagnosed on or before 28 days of life.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
It can lead to [[bradycardia|slowed heart rate]].

==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

==Classification==
*Congenital Heart Block may be classified according to cause into 3 subtypes/groups:
:*Autoimmune
:*Structural
:*Other
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

==Pathophysiology==
Scarring of the conduction system (the heart’s own natural pacemaker), a consequence of [[inflammation]] triggered by the mother’s antibodies, damages or even destroys the cells that allow the heart to beat at a normal rhythm.

[[Neonatal lupus]] (NL) is the name given to a group of conditions that can affect the babies of mothers who have certain [[autoantibody|autoantibodies]] against components of the body’s cells that are called SSA/Ro and SSB/La. Neonatal lupus can appear as a temporary [[rash]] that usually goes away by the time the baby is 6 months old, or very rarely an abnormal blood or [[liver]] condition that also improves with time or it can cause permanent and often life-threatening damage to the fetal heart, known as congenital heart block (CHB). In women with anti-Ro/La antibodies who are pregnant for the first time, only about 2% of the babies will develop congenital heart block. But for a woman who has already had a child with congenital heart block or neonatal lupus rash, the risk of congenital heart block in her next [[pregnancy]] is nearly 20%. Unfortunately, once complete ([[third degree heart block|third degree]]) heart block has been unequivocally identified in a [[fetus]], it has never been reversed with any of the therapies that have been tried to date. If a child is born to a mother with [[lupus]], there is a chance that the child will develop neonatal lupus, especially if the mother is Anti-Ro (SS/A) positive. In the majority of cases, the mother's antibodies will clear from the child in 6 months, however, in a few cases, the affected child will develop complete congenital heart block.

==Causes==
The most common cause of congenital complete heart block is neonatal lupus. It accounts for almost all cases presenting in the intrauterine and neonatal period. Other causes include:
* [[Myocarditis]]
* [[Levo transposition of great arteries]]
* Atrioventricular discordance
* [[Hurler syndrome|Hurler cardiomyopathy]]
* [[Hunter syndrome|Hunter cardiomyopathy]]
* [[Polysplenia]] with atrioventricular canal defect

==Clinical Features==

==Differentiating [disease name] from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:*[Differential dx1]
:*[Differential dx2]
:*[Differential dx3]

==Epidemiology and Demographics==
* The prevalence of congenital heart block is approximately 1 per 22,00 live births individuals worldwide. <ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Pilar Brito-Zeron]], [[Peter M. Izmirly]], [[Manuel Ramos-Casals]], [[Jill P. Buyon]] & [[Munther A. Khamashta]]
| title = The clinical spectrum of autoimmune congenital heart block
| journal = [[Nature reviews. Rheumatology]]
| volume = 11
| issue = 5
| pages = 301–312
| year = 2015
| month = May
| doi = 10.1038/nrrheum.2015.29
| pmid = 25800217
}}</ref>
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

===Age===

*Congential heart block is diagnosed among patients aged from brith to 28 days old.
*Congential heart block is observed among children.

===Gender===
*[Disease name] affects men and women equally.

*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
One form of congenital heart block occurs in babies whose mothers have autoimmune diseases, such as [[SLE|lupus]]. People who have these diseases make proteins called antibodies that attack and damage the body's tissues or cells.

==Natural History, Complications, Prognosis==
===Prognosis===
The damaged heart may beat extremely slowly. In some cases, the heart rate is so slow that it is fatal in nearly 20% of affected babies (with most deaths occurring as [[ fetal demise]]s). Patients presenting as fetuses or at birth have significantly higher morbidity and mortality rates than do patients presenting later in childhood.

*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]

=== Symptoms ===
*Signs and symptoms depend on the type of heart block the child has. [[First-degree heart block]] rarely causes symptoms.
*Symptoms of [[second-degree heart block|second-]] and [[third-degree heart block]] include:
**[[Fainting]]
**[[Dizziness]] or [[light-headedness]]
**[[Fatigue]] ([[tiredness]])
**[[Shortness of breath]]
**[[Chest pain]]

=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*[Imaging study 1] is the imaging modality of choice for [disease name].
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment ==
=== Medical Therapy ===

*The mainstay of [[in utero]] therapy for congenital heart block is [[corticosteroids]].<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Kai-Yu Zhou]] & [[Yi-Min Hua]]
| title = Autoimmune-associated Congenital Heart Block: A New Insight in Fetal Life
| journal = [[Chinese medical journal]]
| volume = 130
| issue = 23
| pages = 2863–2871
| year = 2017
| month = December
| doi = 10.4103/0366-6999.219160
| pmid = 29176145
}}</ref>
*[[Corticosteroids]] act by decreasing [[inflammation]] and damage caused by maternal antibodies.<ref>{{Cite journal
| author = [[Aurelie Ambrosi]] & [[Marie Wahren-Herlenius]]
| title = Congenital heart block: evidence for a pathogenic role of maternal autoantibodies
| journal = [[Arthritis research & therapy]]
| volume = 14
| issue = 2
| pages = 208
| year = 2012
| month = April
| doi = 10.1186/ar3787
| pmid = 22546326
}}</ref>

*Response to [[Corticosteroids]] can be monitored with fetal [[echocardiogram]] every few weeks.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>

=== Surgery ===
*Surgery is the mainstay of therapy for Congenital Heart Block.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
*[[Cardiac pacemaker]] implantation in conjunction with [[Corticosteroids]] is the most common approach to the treatment of Congenital Heart Disease.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Kai-Yu Zhou]] & [[Yi-Min Hua]]
| title = Autoimmune-associated Congenital Heart Block: A New Insight in Fetal Life
| journal = [[Chinese medical journal]]
| volume = 130
| issue = 23
| pages = 2863–2871
| year = 2017
| month = December
| doi = 10.4103/0366-6999.219160
| pmid = 29176145
}}</ref>
*[[Cardiac pacemaker]] implantation can only be performed for patients with [[Mobitz Type II]] and above Congenital Heart Block.<ref>{{Cite journal
| author = [[Kai-Yu Zhou]] & [[Yi-Min Hua]]
| title = Autoimmune-associated Congenital Heart Block: A New Insight in Fetal Life
| journal = [[Chinese medical journal]]
| volume = 130
| issue = 23
| pages = 2863–2871
| year = 2017
| month = December
| doi = 10.4103/0366-6999.219160
| pmid = 29176145
}}</ref>
=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

===Electrocardiogram===
Electrocardiographic findings in congenital heart block depend on the type of block.

==Treatment==
===Surgery===
Treatment depends on the type of heart block.
* [[First-degree heart block]] usually needs no treatment.
* For [[second-degree heart block]], patient may need a [[pacemaker]]. A pacemaker is a small device that's placed under the skin of your chest or [[abdomen]]. This device uses electrical pulses to prompt the heart to beat at a normal rate.
* For [[third-degree heart block]], patient will need a pacemaker.

Nearly all surviving children with congenital heart block require permanent implantation of an [[artificial pacemaker|pacemaker device]].

===Prevention===
Because it is so difficult to treat or repair the damaged heart, a high-priority strategy is to try to prevent the inflammatory process before irreversible scarring can occur. The mother of the child should consult with a rheumatologist to begin monitoring for possible autoimmune disease. Consultation with a rheumatologist is also advised for the infant, particularly if other manifestations of [[neonatal lupus erythematosus]] are present. Genetic consultation is recommended for children with first-degree relatives with structural heart disease or those with storage disorder or [[cardiomyopathy]].

==Source==
* [http://www.clinicaltrials.gov ClinicalTials.gov]

==Related Chapters==
* [[Electrical conduction system of the heart]]
* [[Electrocardiogram]] (ECG or EKG)
* [[SA node]]
* [[AV node]]
* [[Second degree AV block]]
* [[Third degree AV block]]
* [[Bundle branch block]]
* [[Hemiblock]]
* [[Infra-Hisian Block]]
* [[Left anterior fascicular block]]
* [[Left posterior fascicular block]]
* [[Heart block]]
* [[Systemic lupus erythematosus]]
* [[IVIG]]

==References==
{{refbegin|2}}
*Figa FH, McCrindle BW, Bigras JL, et al. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol. Aug 1997;20(8 Pt 1):1902-9.
*Michaelsson M, Jonzon A, Riesenfeld T. Isolated congenital complete atrioventricular block in adult life. A prospective study. Circulation. Aug 1 1995;92(3):442-9. [Full Text].
*Boutjdir M, Chen L, Zhang ZH, et al. Arrhythmogenicity of IgG and anti-52-kD SSA/Ro affinity-purified antibodies from mothers of children with congenital heart block. Circ Res. Mar 1997;80(3):354-62.
*Boutjdir M, Chen L, Zhang ZH, et al. Serum and immunoglobulin G from the mother of a child with congenital heart block induce conduction abnormalities and inhibit L-type calcium channels in a rat heart model. Pediatr Res. Jul 1998;44(1):11-9.
*Claus R, Hickstein H, Kulz T, et al. Identification and management of fetuses at risk for, or affected by, congenital heart block associated with autoantibodies to SSA (Ro), SSB (La), or an HsEg5-like autoantigen. Rheumatol Int. Aug 2006;26(10):886-95.
*Copel JA, Buyon JP, Kleinman CS. Successful in utero therapy of fetal heart block. Am J Obstet Gynecol. Nov 1995;173(5):1384-90.
*Costedoat-Chalumeau N, Amoura Z, Villain E, et al. Anti-SSA/Ro antibodies and the heart: more than complete congenital heart block? A review of electrocardiographic and myocardial abnormalities and of treatment options. Arthritis Res Ther. 2005;7(2):69-73.
*Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, et al. Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. Lupus. 2005;14(9):660-4.
*Cutler NG, Karpawich PP, Cavitt D, et al. Steroid-eluting epicardial pacing electrodes: six year experience of pacing thresholds in a growing pediatric population. Pacing Clin Electrophysiol. Dec 1997;20(12 Pt 1):2943-8.
*Friedman DM, Kim MY, Copel JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation. 2008;117:485-93.
*Friedman DM, Zervoudakis I, Buyon JP. Perinatal monitoring of fetal well-being in the presence of congenital heart block. Am J Perinatol. 1998;15(12):669-73.
*Hamilton R, Gow R, Bahoric B, et al. Steroid-eluting epicardial leads in pediatrics: improved epicardial thresholds in the first year. Pacing Clin Electrophysiol. Nov 1991;14(11 Pt 2):2066-72.
*Hamilton RM, Chiu C, Gow RM, Williams WG. A comparison of two stab-on unipolar epicardial pacing leads in children. Pacing Clin Electrophysiol. Mar 1997;20(3 Pt 1):631-6.
*Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol. Jul 2005;26(1):16-21.
*Karpawich PP, Stokes KB, Proctor K, et al. "In-line" bipolar, steroid-eluting, high impedance, epimyocardial pacing lead. Pacing Clin Electrophysiol. Mar 1998;21(3):503-8.
*Karpawich PP, Walters H, Hakimi M. Chronic performance of a transvenous steroid pacing lead used as an epi- intramyocardial electrode. Pacing Clin Electrophysiol. Jul 1998;21(7):1486-8.
*Miranda-Carus ME, Boutjdir M, Tseng CE. Induction of antibodies reactive with SSA/Ro-SSB/La and development of congenital heart block in a murine model. J Immunol. Dec 1 1998;161(11):5886-92.
*Moak JP, Barron KS, Hougen TJ, et al. Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol. Jan 2001;37(1):238-42.
*Neiman AR, Lee LA, Weston WL, Buyon JP. Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers and children enrolled in a national registry. J Pediatr. Nov 2000;137(5):674-80.
*Rao V, Williams WG, Hamilton RH, et al. Trends in pediatric cardiac pacing. Can J Cardiol. Dec 1995;11(11):993-9.
*Suarez-Penaranda JM, Munoz JI, Rodriguez-Calvo MS, et al. The Pathology of the heart conduction system in congenital heart block. J Clin Forensic Med. Aug-Nov 2006;13(6-8):341-3.
*Weng KP, Chiou CW, Huang SH, et al. The long-term outcome of children with isolated congenital complete atrioventricular block. Acta Paediatr Taiwan. Sep-Oct 2005;46(5):260-7.
{{refend}}

{{Congenital malformations and deformations of circulatory system}}
{{Electrocardiography}}
{{Circulatory system pathology}}
[[Category:Cardiology]]
[[Category:Rheumatology]]
[[Category:Disease]]
[[Category:Congenital disorders]]
[[Category:Developmental biology]]
{{WH}}
{{WS}}

Congenital heart block

2019-09-09T19:10:12Z

Archana Murugan: /* Treatment */

__NOTOC__
{{SI}}

'''For patient information page click [[{{PAGENAME}} (patient information)|here]]'''

{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; '''Contributors:''' [[User:Lakeadam|Adam C. Lake]]

==Overview==
Congenital heart block is a rare [[congenital heart disease]] caused by defects in the heart conduction system diagnosed on or before 28 days of life.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
It can lead to [[bradycardia|slowed heart rate]].

==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

==Classification==
*Congenital Heart Block may be classified according to cause into 3 subtypes/groups:
:*Autoimmune
:*Structural
:*Other
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

==Pathophysiology==
Scarring of the conduction system (the heart’s own natural pacemaker), a consequence of [[inflammation]] triggered by the mother’s antibodies, damages or even destroys the cells that allow the heart to beat at a normal rhythm.

[[Neonatal lupus]] (NL) is the name given to a group of conditions that can affect the babies of mothers who have certain [[autoantibody|autoantibodies]] against components of the body’s cells that are called SSA/Ro and SSB/La. Neonatal lupus can appear as a temporary [[rash]] that usually goes away by the time the baby is 6 months old, or very rarely an abnormal blood or [[liver]] condition that also improves with time or it can cause permanent and often life-threatening damage to the fetal heart, known as congenital heart block (CHB). In women with anti-Ro/La antibodies who are pregnant for the first time, only about 2% of the babies will develop congenital heart block. But for a woman who has already had a child with congenital heart block or neonatal lupus rash, the risk of congenital heart block in her next [[pregnancy]] is nearly 20%. Unfortunately, once complete ([[third degree heart block|third degree]]) heart block has been unequivocally identified in a [[fetus]], it has never been reversed with any of the therapies that have been tried to date. If a child is born to a mother with [[lupus]], there is a chance that the child will develop neonatal lupus, especially if the mother is Anti-Ro (SS/A) positive. In the majority of cases, the mother's antibodies will clear from the child in 6 months, however, in a few cases, the affected child will develop complete congenital heart block.

==Causes==
The most common cause of congenital complete heart block is neonatal lupus. It accounts for almost all cases presenting in the intrauterine and neonatal period. Other causes include:
* [[Myocarditis]]
* [[Levo transposition of great arteries]]
* Atrioventricular discordance
* [[Hurler syndrome|Hurler cardiomyopathy]]
* [[Hunter syndrome|Hunter cardiomyopathy]]
* [[Polysplenia]] with atrioventricular canal defect

==Clinical Features==

==Differentiating [disease name] from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:*[Differential dx1]
:*[Differential dx2]
:*[Differential dx3]

==Epidemiology and Demographics==
* The prevalence of congenital heart block is approximately 1 per 22,00 live births individuals worldwide. <ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Pilar Brito-Zeron]], [[Peter M. Izmirly]], [[Manuel Ramos-Casals]], [[Jill P. Buyon]] & [[Munther A. Khamashta]]
| title = The clinical spectrum of autoimmune congenital heart block
| journal = [[Nature reviews. Rheumatology]]
| volume = 11
| issue = 5
| pages = 301–312
| year = 2015
| month = May
| doi = 10.1038/nrrheum.2015.29
| pmid = 25800217
}}</ref>
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

===Age===

*Congential heart block is diagnosed among patients aged from brith to 28 days old.
*Congential heart block is observed among children.

===Gender===
*[Disease name] affects men and women equally.

*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
One form of congenital heart block occurs in babies whose mothers have autoimmune diseases, such as [[SLE|lupus]]. People who have these diseases make proteins called antibodies that attack and damage the body's tissues or cells.

==Natural History, Complications, Prognosis==
===Prognosis===
The damaged heart may beat extremely slowly. In some cases, the heart rate is so slow that it is fatal in nearly 20% of affected babies (with most deaths occurring as [[ fetal demise]]s). Patients presenting as fetuses or at birth have significantly higher morbidity and mortality rates than do patients presenting later in childhood.

*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]

=== Symptoms ===
*Signs and symptoms depend on the type of heart block the child has. [[First-degree heart block]] rarely causes symptoms.
*Symptoms of [[second-degree heart block|second-]] and [[third-degree heart block]] include:
**[[Fainting]]
**[[Dizziness]] or [[light-headedness]]
**[[Fatigue]] ([[tiredness]])
**[[Shortness of breath]]
**[[Chest pain]]

=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*[Imaging study 1] is the imaging modality of choice for [disease name].
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment ==
=== Medical Therapy ===
*The mainstay of [[in utero]] therapy for congenital heart block is [[corticosteroids]].<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Kai-Yu Zhou]] & [[Yi-Min Hua]]
| title = Autoimmune-associated Congenital Heart Block: A New Insight in Fetal Life
| journal = [[Chinese medical journal]]
| volume = 130
| issue = 23
| pages = 2863–2871
| year = 2017
| month = December
| doi = 10.4103/0366-6999.219160
| pmid = 29176145
}}</ref>
*[[Corticosteroids]] act by decreasing [[inflammation]] and damage caused by maternal antibodies.<ref>{{Cite journal
| author = [[Aurelie Ambrosi]] & [[Marie Wahren-Herlenius]]
| title = Congenital heart block: evidence for a pathogenic role of maternal autoantibodies
| journal = [[Arthritis research & therapy]]
| volume = 14
| issue = 2
| pages = 208
| year = 2012
| month = April
| doi = 10.1186/ar3787
| pmid = 22546326
}}</ref>

*Response to [[Corticosteroids]] can be monitored with fetal [[echocardiogram]] every few weeks.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>

=== Surgery ===
*Surgery is the mainstay of therapy for Congenital Heart Block.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
*[[Cardiac pacemaker]] implantation in conjunction with [[Corticosteroids]] is the most common approach to the treatment of Congenital Heart Disease.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Kai-Yu Zhou]] & [[Yi-Min Hua]]
| title = Autoimmune-associated Congenital Heart Block: A New Insight in Fetal Life
| journal = [[Chinese medical journal]]
| volume = 130
| issue = 23
| pages = 2863–2871
| year = 2017
| month = December
| doi = 10.4103/0366-6999.219160
| pmid = 29176145
}}</ref>
*[[Cardiac pacemaker]] implantation can only be performed for patients with [[Mobitz Type II]] and above Congenital Heart Block.<ref>{{Cite journal
| author = [[Kai-Yu Zhou]] & [[Yi-Min Hua]]
| title = Autoimmune-associated Congenital Heart Block: A New Insight in Fetal Life
| journal = [[Chinese medical journal]]
| volume = 130
| issue = 23
| pages = 2863–2871
| year = 2017
| month = December
| doi = 10.4103/0366-6999.219160
| pmid = 29176145
}}</ref>
=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

===Electrocardiogram===
Electrocardiographic findings in congenital heart block depend on the type of block.

==Treatment==
===Surgery===
Treatment depends on the type of heart block.
* [[First-degree heart block]] usually needs no treatment.
* For [[second-degree heart block]], patient may need a [[pacemaker]]. A pacemaker is a small device that's placed under the skin of your chest or [[abdomen]]. This device uses electrical pulses to prompt the heart to beat at a normal rate.
* For [[third-degree heart block]], patient will need a pacemaker.

Nearly all surviving children with congenital heart block require permanent implantation of an [[artificial pacemaker|pacemaker device]].

===Prevention===
Because it is so difficult to treat or repair the damaged heart, a high-priority strategy is to try to prevent the inflammatory process before irreversible scarring can occur. The mother of the child should consult with a rheumatologist to begin monitoring for possible autoimmune disease. Consultation with a rheumatologist is also advised for the infant, particularly if other manifestations of [[neonatal lupus erythematosus]] are present. Genetic consultation is recommended for children with first-degree relatives with structural heart disease or those with storage disorder or [[cardiomyopathy]].

==Source==
* [http://www.clinicaltrials.gov ClinicalTials.gov]

==Related Chapters==
* [[Electrical conduction system of the heart]]
* [[Electrocardiogram]] (ECG or EKG)
* [[SA node]]
* [[AV node]]
* [[Second degree AV block]]
* [[Third degree AV block]]
* [[Bundle branch block]]
* [[Hemiblock]]
* [[Infra-Hisian Block]]
* [[Left anterior fascicular block]]
* [[Left posterior fascicular block]]
* [[Heart block]]
* [[Systemic lupus erythematosus]]
* [[IVIG]]

==References==
{{refbegin|2}}
*Figa FH, McCrindle BW, Bigras JL, et al. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol. Aug 1997;20(8 Pt 1):1902-9.
*Michaelsson M, Jonzon A, Riesenfeld T. Isolated congenital complete atrioventricular block in adult life. A prospective study. Circulation. Aug 1 1995;92(3):442-9. [Full Text].
*Boutjdir M, Chen L, Zhang ZH, et al. Arrhythmogenicity of IgG and anti-52-kD SSA/Ro affinity-purified antibodies from mothers of children with congenital heart block. Circ Res. Mar 1997;80(3):354-62.
*Boutjdir M, Chen L, Zhang ZH, et al. Serum and immunoglobulin G from the mother of a child with congenital heart block induce conduction abnormalities and inhibit L-type calcium channels in a rat heart model. Pediatr Res. Jul 1998;44(1):11-9.
*Claus R, Hickstein H, Kulz T, et al. Identification and management of fetuses at risk for, or affected by, congenital heart block associated with autoantibodies to SSA (Ro), SSB (La), or an HsEg5-like autoantigen. Rheumatol Int. Aug 2006;26(10):886-95.
*Copel JA, Buyon JP, Kleinman CS. Successful in utero therapy of fetal heart block. Am J Obstet Gynecol. Nov 1995;173(5):1384-90.
*Costedoat-Chalumeau N, Amoura Z, Villain E, et al. Anti-SSA/Ro antibodies and the heart: more than complete congenital heart block? A review of electrocardiographic and myocardial abnormalities and of treatment options. Arthritis Res Ther. 2005;7(2):69-73.
*Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, et al. Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. Lupus. 2005;14(9):660-4.
*Cutler NG, Karpawich PP, Cavitt D, et al. Steroid-eluting epicardial pacing electrodes: six year experience of pacing thresholds in a growing pediatric population. Pacing Clin Electrophysiol. Dec 1997;20(12 Pt 1):2943-8.
*Friedman DM, Kim MY, Copel JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation. 2008;117:485-93.
*Friedman DM, Zervoudakis I, Buyon JP. Perinatal monitoring of fetal well-being in the presence of congenital heart block. Am J Perinatol. 1998;15(12):669-73.
*Hamilton R, Gow R, Bahoric B, et al. Steroid-eluting epicardial leads in pediatrics: improved epicardial thresholds in the first year. Pacing Clin Electrophysiol. Nov 1991;14(11 Pt 2):2066-72.
*Hamilton RM, Chiu C, Gow RM, Williams WG. A comparison of two stab-on unipolar epicardial pacing leads in children. Pacing Clin Electrophysiol. Mar 1997;20(3 Pt 1):631-6.
*Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol. Jul 2005;26(1):16-21.
*Karpawich PP, Stokes KB, Proctor K, et al. "In-line" bipolar, steroid-eluting, high impedance, epimyocardial pacing lead. Pacing Clin Electrophysiol. Mar 1998;21(3):503-8.
*Karpawich PP, Walters H, Hakimi M. Chronic performance of a transvenous steroid pacing lead used as an epi- intramyocardial electrode. Pacing Clin Electrophysiol. Jul 1998;21(7):1486-8.
*Miranda-Carus ME, Boutjdir M, Tseng CE. Induction of antibodies reactive with SSA/Ro-SSB/La and development of congenital heart block in a murine model. J Immunol. Dec 1 1998;161(11):5886-92.
*Moak JP, Barron KS, Hougen TJ, et al. Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol. Jan 2001;37(1):238-42.
*Neiman AR, Lee LA, Weston WL, Buyon JP. Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers and children enrolled in a national registry. J Pediatr. Nov 2000;137(5):674-80.
*Rao V, Williams WG, Hamilton RH, et al. Trends in pediatric cardiac pacing. Can J Cardiol. Dec 1995;11(11):993-9.
*Suarez-Penaranda JM, Munoz JI, Rodriguez-Calvo MS, et al. The Pathology of the heart conduction system in congenital heart block. J Clin Forensic Med. Aug-Nov 2006;13(6-8):341-3.
*Weng KP, Chiou CW, Huang SH, et al. The long-term outcome of children with isolated congenital complete atrioventricular block. Acta Paediatr Taiwan. Sep-Oct 2005;46(5):260-7.
{{refend}}

{{Congenital malformations and deformations of circulatory system}}
{{Electrocardiography}}
{{Circulatory system pathology}}
[[Category:Cardiology]]
[[Category:Rheumatology]]
[[Category:Disease]]
[[Category:Congenital disorders]]
[[Category:Developmental biology]]
{{WH}}
{{WS}}

Congenital heart block

2019-09-09T19:02:34Z

Archana Murugan: /* Treatment */

__NOTOC__
{{SI}}

'''For patient information page click [[{{PAGENAME}} (patient information)|here]]'''

{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; '''Contributors:''' [[User:Lakeadam|Adam C. Lake]]

==Overview==
Congenital heart block is a rare [[congenital heart disease]] caused by defects in the heart conduction system diagnosed on or before 28 days of life.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
It can lead to [[bradycardia|slowed heart rate]].

==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

==Classification==
*Congenital Heart Block may be classified according to cause into 3 subtypes/groups:
:*Autoimmune
:*Structural
:*Other
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

==Pathophysiology==
Scarring of the conduction system (the heart’s own natural pacemaker), a consequence of [[inflammation]] triggered by the mother’s antibodies, damages or even destroys the cells that allow the heart to beat at a normal rhythm.

[[Neonatal lupus]] (NL) is the name given to a group of conditions that can affect the babies of mothers who have certain [[autoantibody|autoantibodies]] against components of the body’s cells that are called SSA/Ro and SSB/La. Neonatal lupus can appear as a temporary [[rash]] that usually goes away by the time the baby is 6 months old, or very rarely an abnormal blood or [[liver]] condition that also improves with time or it can cause permanent and often life-threatening damage to the fetal heart, known as congenital heart block (CHB). In women with anti-Ro/La antibodies who are pregnant for the first time, only about 2% of the babies will develop congenital heart block. But for a woman who has already had a child with congenital heart block or neonatal lupus rash, the risk of congenital heart block in her next [[pregnancy]] is nearly 20%. Unfortunately, once complete ([[third degree heart block|third degree]]) heart block has been unequivocally identified in a [[fetus]], it has never been reversed with any of the therapies that have been tried to date. If a child is born to a mother with [[lupus]], there is a chance that the child will develop neonatal lupus, especially if the mother is Anti-Ro (SS/A) positive. In the majority of cases, the mother's antibodies will clear from the child in 6 months, however, in a few cases, the affected child will develop complete congenital heart block.

==Causes==
The most common cause of congenital complete heart block is neonatal lupus. It accounts for almost all cases presenting in the intrauterine and neonatal period. Other causes include:
* [[Myocarditis]]
* [[Levo transposition of great arteries]]
* Atrioventricular discordance
* [[Hurler syndrome|Hurler cardiomyopathy]]
* [[Hunter syndrome|Hunter cardiomyopathy]]
* [[Polysplenia]] with atrioventricular canal defect

==Clinical Features==

==Differentiating [disease name] from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:*[Differential dx1]
:*[Differential dx2]
:*[Differential dx3]

==Epidemiology and Demographics==
* The prevalence of congenital heart block is approximately 1 per 22,00 live births individuals worldwide. <ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Pilar Brito-Zeron]], [[Peter M. Izmirly]], [[Manuel Ramos-Casals]], [[Jill P. Buyon]] & [[Munther A. Khamashta]]
| title = The clinical spectrum of autoimmune congenital heart block
| journal = [[Nature reviews. Rheumatology]]
| volume = 11
| issue = 5
| pages = 301–312
| year = 2015
| month = May
| doi = 10.1038/nrrheum.2015.29
| pmid = 25800217
}}</ref>
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

===Age===

*Congential heart block is diagnosed among patients aged from brith to 28 days old.
*Congential heart block is observed among children.

===Gender===
*[Disease name] affects men and women equally.

*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
One form of congenital heart block occurs in babies whose mothers have autoimmune diseases, such as [[SLE|lupus]]. People who have these diseases make proteins called antibodies that attack and damage the body's tissues or cells.

==Natural History, Complications, Prognosis==
===Prognosis===
The damaged heart may beat extremely slowly. In some cases, the heart rate is so slow that it is fatal in nearly 20% of affected babies (with most deaths occurring as [[ fetal demise]]s). Patients presenting as fetuses or at birth have significantly higher morbidity and mortality rates than do patients presenting later in childhood.

*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]

=== Symptoms ===
*Signs and symptoms depend on the type of heart block the child has. [[First-degree heart block]] rarely causes symptoms.
*Symptoms of [[second-degree heart block|second-]] and [[third-degree heart block]] include:
**[[Fainting]]
**[[Dizziness]] or [[light-headedness]]
**[[Fatigue]] ([[tiredness]])
**[[Shortness of breath]]
**[[Chest pain]]

=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*[Imaging study 1] is the imaging modality of choice for [disease name].
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment ==
=== Medical Therapy ===

*The mainstay of [[in utero]] therapy for congenital heart block is [[corticosteroids]] .
*[[Corticosteroids]] act by decreasing [[inflammation]] and damage caused by maternal antibodies.
*Response to [[Corticosteroids]] can be monitored with fetal [[echocardiogram]] every few weeks.

=== Surgery ===
*Surgery is the mainstay of therapy for Congenital Heart Block.
*[[Cardiac pacemaker]] implantation in conjunction with [[Corticosteroids]] is the most common approach to the treatment of Congenital Heart Disease.
*[[Cardiac pacemaker]] implantation can only be performed for patients with [[Mobitz Type II]] and above Congenital Heart Block.

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

===Electrocardiogram===
Electrocardiographic findings in congenital heart block depend on the type of block.

==Treatment==
===Surgery===
Treatment depends on the type of heart block.
* [[First-degree heart block]] usually needs no treatment.
* For [[second-degree heart block]], patient may need a [[pacemaker]]. A pacemaker is a small device that's placed under the skin of your chest or [[abdomen]]. This device uses electrical pulses to prompt the heart to beat at a normal rate.
* For [[third-degree heart block]], patient will need a pacemaker.

Nearly all surviving children with congenital heart block require permanent implantation of an [[artificial pacemaker|pacemaker device]].

===Prevention===
Because it is so difficult to treat or repair the damaged heart, a high-priority strategy is to try to prevent the inflammatory process before irreversible scarring can occur. The mother of the child should consult with a rheumatologist to begin monitoring for possible autoimmune disease. Consultation with a rheumatologist is also advised for the infant, particularly if other manifestations of [[neonatal lupus erythematosus]] are present. Genetic consultation is recommended for children with first-degree relatives with structural heart disease or those with storage disorder or [[cardiomyopathy]].

==Source==
* [http://www.clinicaltrials.gov ClinicalTials.gov]

==Related Chapters==
* [[Electrical conduction system of the heart]]
* [[Electrocardiogram]] (ECG or EKG)
* [[SA node]]
* [[AV node]]
* [[Second degree AV block]]
* [[Third degree AV block]]
* [[Bundle branch block]]
* [[Hemiblock]]
* [[Infra-Hisian Block]]
* [[Left anterior fascicular block]]
* [[Left posterior fascicular block]]
* [[Heart block]]
* [[Systemic lupus erythematosus]]
* [[IVIG]]

==References==
{{refbegin|2}}
*Figa FH, McCrindle BW, Bigras JL, et al. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol. Aug 1997;20(8 Pt 1):1902-9.
*Michaelsson M, Jonzon A, Riesenfeld T. Isolated congenital complete atrioventricular block in adult life. A prospective study. Circulation. Aug 1 1995;92(3):442-9. [Full Text].
*Boutjdir M, Chen L, Zhang ZH, et al. Arrhythmogenicity of IgG and anti-52-kD SSA/Ro affinity-purified antibodies from mothers of children with congenital heart block. Circ Res. Mar 1997;80(3):354-62.
*Boutjdir M, Chen L, Zhang ZH, et al. Serum and immunoglobulin G from the mother of a child with congenital heart block induce conduction abnormalities and inhibit L-type calcium channels in a rat heart model. Pediatr Res. Jul 1998;44(1):11-9.
*Claus R, Hickstein H, Kulz T, et al. Identification and management of fetuses at risk for, or affected by, congenital heart block associated with autoantibodies to SSA (Ro), SSB (La), or an HsEg5-like autoantigen. Rheumatol Int. Aug 2006;26(10):886-95.
*Copel JA, Buyon JP, Kleinman CS. Successful in utero therapy of fetal heart block. Am J Obstet Gynecol. Nov 1995;173(5):1384-90.
*Costedoat-Chalumeau N, Amoura Z, Villain E, et al. Anti-SSA/Ro antibodies and the heart: more than complete congenital heart block? A review of electrocardiographic and myocardial abnormalities and of treatment options. Arthritis Res Ther. 2005;7(2):69-73.
*Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, et al. Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. Lupus. 2005;14(9):660-4.
*Cutler NG, Karpawich PP, Cavitt D, et al. Steroid-eluting epicardial pacing electrodes: six year experience of pacing thresholds in a growing pediatric population. Pacing Clin Electrophysiol. Dec 1997;20(12 Pt 1):2943-8.
*Friedman DM, Kim MY, Copel JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation. 2008;117:485-93.
*Friedman DM, Zervoudakis I, Buyon JP. Perinatal monitoring of fetal well-being in the presence of congenital heart block. Am J Perinatol. 1998;15(12):669-73.
*Hamilton R, Gow R, Bahoric B, et al. Steroid-eluting epicardial leads in pediatrics: improved epicardial thresholds in the first year. Pacing Clin Electrophysiol. Nov 1991;14(11 Pt 2):2066-72.
*Hamilton RM, Chiu C, Gow RM, Williams WG. A comparison of two stab-on unipolar epicardial pacing leads in children. Pacing Clin Electrophysiol. Mar 1997;20(3 Pt 1):631-6.
*Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol. Jul 2005;26(1):16-21.
*Karpawich PP, Stokes KB, Proctor K, et al. "In-line" bipolar, steroid-eluting, high impedance, epimyocardial pacing lead. Pacing Clin Electrophysiol. Mar 1998;21(3):503-8.
*Karpawich PP, Walters H, Hakimi M. Chronic performance of a transvenous steroid pacing lead used as an epi- intramyocardial electrode. Pacing Clin Electrophysiol. Jul 1998;21(7):1486-8.
*Miranda-Carus ME, Boutjdir M, Tseng CE. Induction of antibodies reactive with SSA/Ro-SSB/La and development of congenital heart block in a murine model. J Immunol. Dec 1 1998;161(11):5886-92.
*Moak JP, Barron KS, Hougen TJ, et al. Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol. Jan 2001;37(1):238-42.
*Neiman AR, Lee LA, Weston WL, Buyon JP. Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers and children enrolled in a national registry. J Pediatr. Nov 2000;137(5):674-80.
*Rao V, Williams WG, Hamilton RH, et al. Trends in pediatric cardiac pacing. Can J Cardiol. Dec 1995;11(11):993-9.
*Suarez-Penaranda JM, Munoz JI, Rodriguez-Calvo MS, et al. The Pathology of the heart conduction system in congenital heart block. J Clin Forensic Med. Aug-Nov 2006;13(6-8):341-3.
*Weng KP, Chiou CW, Huang SH, et al. The long-term outcome of children with isolated congenital complete atrioventricular block. Acta Paediatr Taiwan. Sep-Oct 2005;46(5):260-7.
{{refend}}

{{Congenital malformations and deformations of circulatory system}}
{{Electrocardiography}}
{{Circulatory system pathology}}
[[Category:Cardiology]]
[[Category:Rheumatology]]
[[Category:Disease]]
[[Category:Congenital disorders]]
[[Category:Developmental biology]]
{{WH}}
{{WS}}

Congenital heart block

2019-09-03T22:22:45Z

Archana Murugan: /* Epidemiology and Demographics */

__NOTOC__
{{SI}}

'''For patient information page click [[{{PAGENAME}} (patient information)|here]]'''

{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; '''Contributors:''' [[User:Lakeadam|Adam C. Lake]]

==Overview==
Congenital heart block is a rare [[congenital heart disease]] caused by defects in the heart conduction system diagnosed on or before 28 days of life.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
It can lead to [[bradycardia|slowed heart rate]].

==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

==Classification==
*Congenital Heart Block may be classified according to cause into 3 subtypes/groups:
:*Autoimmune
:*Structural
:*Other
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

==Pathophysiology==
Scarring of the conduction system (the heart’s own natural pacemaker), a consequence of [[inflammation]] triggered by the mother’s antibodies, damages or even destroys the cells that allow the heart to beat at a normal rhythm.

[[Neonatal lupus]] (NL) is the name given to a group of conditions that can affect the babies of mothers who have certain [[autoantibody|autoantibodies]] against components of the body’s cells that are called SSA/Ro and SSB/La. Neonatal lupus can appear as a temporary [[rash]] that usually goes away by the time the baby is 6 months old, or very rarely an abnormal blood or [[liver]] condition that also improves with time or it can cause permanent and often life-threatening damage to the fetal heart, known as congenital heart block (CHB). In women with anti-Ro/La antibodies who are pregnant for the first time, only about 2% of the babies will develop congenital heart block. But for a woman who has already had a child with congenital heart block or neonatal lupus rash, the risk of congenital heart block in her next [[pregnancy]] is nearly 20%. Unfortunately, once complete ([[third degree heart block|third degree]]) heart block has been unequivocally identified in a [[fetus]], it has never been reversed with any of the therapies that have been tried to date. If a child is born to a mother with [[lupus]], there is a chance that the child will develop neonatal lupus, especially if the mother is Anti-Ro (SS/A) positive. In the majority of cases, the mother's antibodies will clear from the child in 6 months, however, in a few cases, the affected child will develop complete congenital heart block.

==Causes==
The most common cause of congenital complete heart block is neonatal lupus. It accounts for almost all cases presenting in the intrauterine and neonatal period. Other causes include:
* [[Myocarditis]]
* [[Levo transposition of great arteries]]
* Atrioventricular discordance
* [[Hurler syndrome|Hurler cardiomyopathy]]
* [[Hunter syndrome|Hunter cardiomyopathy]]
* [[Polysplenia]] with atrioventricular canal defect

==Clinical Features==

==Differentiating [disease name] from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:*[Differential dx1]
:*[Differential dx2]
:*[Differential dx3]

==Epidemiology and Demographics==
* The prevalence of congenital heart block is approximately 1 per 22,00 live births individuals worldwide. <ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref><ref>{{Cite journal
| author = [[Pilar Brito-Zeron]], [[Peter M. Izmirly]], [[Manuel Ramos-Casals]], [[Jill P. Buyon]] & [[Munther A. Khamashta]]
| title = The clinical spectrum of autoimmune congenital heart block
| journal = [[Nature reviews. Rheumatology]]
| volume = 11
| issue = 5
| pages = 301–312
| year = 2015
| month = May
| doi = 10.1038/nrrheum.2015.29
| pmid = 25800217
}}</ref>
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

===Age===

*Congential heart block is diagnosed among patients aged from brith to 28 days old.
*Congential heart block is observed among children.

===Gender===
*[Disease name] affects men and women equally.

*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
One form of congenital heart block occurs in babies whose mothers have autoimmune diseases, such as [[SLE|lupus]]. People who have these diseases make proteins called antibodies that attack and damage the body's tissues or cells.

==Natural History, Complications, Prognosis==
===Prognosis===
The damaged heart may beat extremely slowly. In some cases, the heart rate is so slow that it is fatal in nearly 20% of affected babies (with most deaths occurring as [[ fetal demise]]s). Patients presenting as fetuses or at birth have significantly higher morbidity and mortality rates than do patients presenting later in childhood.

*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]

=== Symptoms ===
*Signs and symptoms depend on the type of heart block the child has. [[First-degree heart block]] rarely causes symptoms.
*Symptoms of [[second-degree heart block|second-]] and [[third-degree heart block]] include:
**[[Fainting]]
**[[Dizziness]] or [[light-headedness]]
**[[Fatigue]] ([[tiredness]])
**[[Shortness of breath]]
**[[Chest pain]]

=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*[Imaging study 1] is the imaging modality of choice for [disease name].
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment ==
=== Medical Therapy ===
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.

*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

===Electrocardiogram===
Electrocardiographic findings in congenital heart block depend on the type of block.

==Treatment==
===Surgery===
Treatment depends on the type of heart block.
* [[First-degree heart block]] usually needs no treatment.
* For [[second-degree heart block]], patient may need a [[pacemaker]]. A pacemaker is a small device that's placed under the skin of your chest or [[abdomen]]. This device uses electrical pulses to prompt the heart to beat at a normal rate.
* For [[third-degree heart block]], patient will need a pacemaker.

Nearly all surviving children with congenital heart block require permanent implantation of an [[artificial pacemaker|pacemaker device]].

===Prevention===
Because it is so difficult to treat or repair the damaged heart, a high-priority strategy is to try to prevent the inflammatory process before irreversible scarring can occur. The mother of the child should consult with a rheumatologist to begin monitoring for possible autoimmune disease. Consultation with a rheumatologist is also advised for the infant, particularly if other manifestations of [[neonatal lupus erythematosus]] are present. Genetic consultation is recommended for children with first-degree relatives with structural heart disease or those with storage disorder or [[cardiomyopathy]].

==Source==
* [http://www.clinicaltrials.gov ClinicalTials.gov]

==Related Chapters==
* [[Electrical conduction system of the heart]]
* [[Electrocardiogram]] (ECG or EKG)
* [[SA node]]
* [[AV node]]
* [[Second degree AV block]]
* [[Third degree AV block]]
* [[Bundle branch block]]
* [[Hemiblock]]
* [[Infra-Hisian Block]]
* [[Left anterior fascicular block]]
* [[Left posterior fascicular block]]
* [[Heart block]]
* [[Systemic lupus erythematosus]]
* [[IVIG]]

==References==
{{refbegin|2}}
*Figa FH, McCrindle BW, Bigras JL, et al. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol. Aug 1997;20(8 Pt 1):1902-9.
*Michaelsson M, Jonzon A, Riesenfeld T. Isolated congenital complete atrioventricular block in adult life. A prospective study. Circulation. Aug 1 1995;92(3):442-9. [Full Text].
*Boutjdir M, Chen L, Zhang ZH, et al. Arrhythmogenicity of IgG and anti-52-kD SSA/Ro affinity-purified antibodies from mothers of children with congenital heart block. Circ Res. Mar 1997;80(3):354-62.
*Boutjdir M, Chen L, Zhang ZH, et al. Serum and immunoglobulin G from the mother of a child with congenital heart block induce conduction abnormalities and inhibit L-type calcium channels in a rat heart model. Pediatr Res. Jul 1998;44(1):11-9.
*Claus R, Hickstein H, Kulz T, et al. Identification and management of fetuses at risk for, or affected by, congenital heart block associated with autoantibodies to SSA (Ro), SSB (La), or an HsEg5-like autoantigen. Rheumatol Int. Aug 2006;26(10):886-95.
*Copel JA, Buyon JP, Kleinman CS. Successful in utero therapy of fetal heart block. Am J Obstet Gynecol. Nov 1995;173(5):1384-90.
*Costedoat-Chalumeau N, Amoura Z, Villain E, et al. Anti-SSA/Ro antibodies and the heart: more than complete congenital heart block? A review of electrocardiographic and myocardial abnormalities and of treatment options. Arthritis Res Ther. 2005;7(2):69-73.
*Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, et al. Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. Lupus. 2005;14(9):660-4.
*Cutler NG, Karpawich PP, Cavitt D, et al. Steroid-eluting epicardial pacing electrodes: six year experience of pacing thresholds in a growing pediatric population. Pacing Clin Electrophysiol. Dec 1997;20(12 Pt 1):2943-8.
*Friedman DM, Kim MY, Copel JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation. 2008;117:485-93.
*Friedman DM, Zervoudakis I, Buyon JP. Perinatal monitoring of fetal well-being in the presence of congenital heart block. Am J Perinatol. 1998;15(12):669-73.
*Hamilton R, Gow R, Bahoric B, et al. Steroid-eluting epicardial leads in pediatrics: improved epicardial thresholds in the first year. Pacing Clin Electrophysiol. Nov 1991;14(11 Pt 2):2066-72.
*Hamilton RM, Chiu C, Gow RM, Williams WG. A comparison of two stab-on unipolar epicardial pacing leads in children. Pacing Clin Electrophysiol. Mar 1997;20(3 Pt 1):631-6.
*Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol. Jul 2005;26(1):16-21.
*Karpawich PP, Stokes KB, Proctor K, et al. "In-line" bipolar, steroid-eluting, high impedance, epimyocardial pacing lead. Pacing Clin Electrophysiol. Mar 1998;21(3):503-8.
*Karpawich PP, Walters H, Hakimi M. Chronic performance of a transvenous steroid pacing lead used as an epi- intramyocardial electrode. Pacing Clin Electrophysiol. Jul 1998;21(7):1486-8.
*Miranda-Carus ME, Boutjdir M, Tseng CE. Induction of antibodies reactive with SSA/Ro-SSB/La and development of congenital heart block in a murine model. J Immunol. Dec 1 1998;161(11):5886-92.
*Moak JP, Barron KS, Hougen TJ, et al. Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol. Jan 2001;37(1):238-42.
*Neiman AR, Lee LA, Weston WL, Buyon JP. Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers and children enrolled in a national registry. J Pediatr. Nov 2000;137(5):674-80.
*Rao V, Williams WG, Hamilton RH, et al. Trends in pediatric cardiac pacing. Can J Cardiol. Dec 1995;11(11):993-9.
*Suarez-Penaranda JM, Munoz JI, Rodriguez-Calvo MS, et al. The Pathology of the heart conduction system in congenital heart block. J Clin Forensic Med. Aug-Nov 2006;13(6-8):341-3.
*Weng KP, Chiou CW, Huang SH, et al. The long-term outcome of children with isolated congenital complete atrioventricular block. Acta Paediatr Taiwan. Sep-Oct 2005;46(5):260-7.
{{refend}}

{{Congenital malformations and deformations of circulatory system}}
{{Electrocardiography}}
{{Circulatory system pathology}}
[[Category:Cardiology]]
[[Category:Rheumatology]]
[[Category:Disease]]
[[Category:Congenital disorders]]
[[Category:Developmental biology]]
{{WH}}
{{WS}}

Congenital heart block

2019-08-29T16:24:45Z

Archana Murugan: /* Age */

__NOTOC__
{{SI}}

'''For patient information page click [[{{PAGENAME}} (patient information)|here]]'''

{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; '''Contributors:''' [[User:Lakeadam|Adam C. Lake]]

==Overview==
Congenital heart block is a rare [[congenital heart disease]] caused by defects in the heart conduction system diagnosed on or before 28 days of life.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
It can lead to [[bradycardia|slowed heart rate]].

==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

==Classification==
*Congenital Heart Block may be classified according to cause into 3 subtypes/groups:
:*Autoimmune
:*Structural
:*Other
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

==Pathophysiology==
Scarring of the conduction system (the heart’s own natural pacemaker), a consequence of [[inflammation]] triggered by the mother’s antibodies, damages or even destroys the cells that allow the heart to beat at a normal rhythm.

[[Neonatal lupus]] (NL) is the name given to a group of conditions that can affect the babies of mothers who have certain [[autoantibody|autoantibodies]] against components of the body’s cells that are called SSA/Ro and SSB/La. Neonatal lupus can appear as a temporary [[rash]] that usually goes away by the time the baby is 6 months old, or very rarely an abnormal blood or [[liver]] condition that also improves with time or it can cause permanent and often life-threatening damage to the fetal heart, known as congenital heart block (CHB). In women with anti-Ro/La antibodies who are pregnant for the first time, only about 2% of the babies will develop congenital heart block. But for a woman who has already had a child with congenital heart block or neonatal lupus rash, the risk of congenital heart block in her next [[pregnancy]] is nearly 20%. Unfortunately, once complete ([[third degree heart block|third degree]]) heart block has been unequivocally identified in a [[fetus]], it has never been reversed with any of the therapies that have been tried to date. If a child is born to a mother with [[lupus]], there is a chance that the child will develop neonatal lupus, especially if the mother is Anti-Ro (SS/A) positive. In the majority of cases, the mother's antibodies will clear from the child in 6 months, however, in a few cases, the affected child will develop complete congenital heart block.

==Causes==
The most common cause of congenital complete heart block is neonatal lupus. It accounts for almost all cases presenting in the intrauterine and neonatal period. Other causes include:
* [[Myocarditis]]
* [[Levo transposition of great arteries]]
* Atrioventricular discordance
* [[Hurler syndrome|Hurler cardiomyopathy]]
* [[Hunter syndrome|Hunter cardiomyopathy]]
* [[Polysplenia]] with atrioventricular canal defect

==Clinical Features==

==Differentiating [disease name] from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:*[Differential dx1]
:*[Differential dx2]
:*[Differential dx3]

==Epidemiology and Demographics==
* The prevalence of congenital heart block is approximately 1 per 22,00 live births individuals worldwide. <ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

===Age===

*Congential heart block is diagnosed among patients aged from brith to 28 days old.
*Congential heart block is observed among children.

===Gender===
*[Disease name] affects men and women equally.

*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
One form of congenital heart block occurs in babies whose mothers have autoimmune diseases, such as [[SLE|lupus]]. People who have these diseases make proteins called antibodies that attack and damage the body's tissues or cells.

==Natural History, Complications, Prognosis==
===Prognosis===
The damaged heart may beat extremely slowly. In some cases, the heart rate is so slow that it is fatal in nearly 20% of affected babies (with most deaths occurring as [[ fetal demise]]s). Patients presenting as fetuses or at birth have significantly higher morbidity and mortality rates than do patients presenting later in childhood.

*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]

=== Symptoms ===
*Signs and symptoms depend on the type of heart block the child has. [[First-degree heart block]] rarely causes symptoms.
*Symptoms of [[second-degree heart block|second-]] and [[third-degree heart block]] include:
**[[Fainting]]
**[[Dizziness]] or [[light-headedness]]
**[[Fatigue]] ([[tiredness]])
**[[Shortness of breath]]
**[[Chest pain]]

=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*[Imaging study 1] is the imaging modality of choice for [disease name].
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment ==
=== Medical Therapy ===
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.

*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

===Electrocardiogram===
Electrocardiographic findings in congenital heart block depend on the type of block.

==Treatment==
===Surgery===
Treatment depends on the type of heart block.
* [[First-degree heart block]] usually needs no treatment.
* For [[second-degree heart block]], patient may need a [[pacemaker]]. A pacemaker is a small device that's placed under the skin of your chest or [[abdomen]]. This device uses electrical pulses to prompt the heart to beat at a normal rate.
* For [[third-degree heart block]], patient will need a pacemaker.

Nearly all surviving children with congenital heart block require permanent implantation of an [[artificial pacemaker|pacemaker device]].

===Prevention===
Because it is so difficult to treat or repair the damaged heart, a high-priority strategy is to try to prevent the inflammatory process before irreversible scarring can occur. The mother of the child should consult with a rheumatologist to begin monitoring for possible autoimmune disease. Consultation with a rheumatologist is also advised for the infant, particularly if other manifestations of [[neonatal lupus erythematosus]] are present. Genetic consultation is recommended for children with first-degree relatives with structural heart disease or those with storage disorder or [[cardiomyopathy]].

==Source==
* [http://www.clinicaltrials.gov ClinicalTials.gov]

==Related Chapters==
* [[Electrical conduction system of the heart]]
* [[Electrocardiogram]] (ECG or EKG)
* [[SA node]]
* [[AV node]]
* [[Second degree AV block]]
* [[Third degree AV block]]
* [[Bundle branch block]]
* [[Hemiblock]]
* [[Infra-Hisian Block]]
* [[Left anterior fascicular block]]
* [[Left posterior fascicular block]]
* [[Heart block]]
* [[Systemic lupus erythematosus]]
* [[IVIG]]

==References==
{{refbegin|2}}
*Figa FH, McCrindle BW, Bigras JL, et al. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol. Aug 1997;20(8 Pt 1):1902-9.
*Michaelsson M, Jonzon A, Riesenfeld T. Isolated congenital complete atrioventricular block in adult life. A prospective study. Circulation. Aug 1 1995;92(3):442-9. [Full Text].
*Boutjdir M, Chen L, Zhang ZH, et al. Arrhythmogenicity of IgG and anti-52-kD SSA/Ro affinity-purified antibodies from mothers of children with congenital heart block. Circ Res. Mar 1997;80(3):354-62.
*Boutjdir M, Chen L, Zhang ZH, et al. Serum and immunoglobulin G from the mother of a child with congenital heart block induce conduction abnormalities and inhibit L-type calcium channels in a rat heart model. Pediatr Res. Jul 1998;44(1):11-9.
*Claus R, Hickstein H, Kulz T, et al. Identification and management of fetuses at risk for, or affected by, congenital heart block associated with autoantibodies to SSA (Ro), SSB (La), or an HsEg5-like autoantigen. Rheumatol Int. Aug 2006;26(10):886-95.
*Copel JA, Buyon JP, Kleinman CS. Successful in utero therapy of fetal heart block. Am J Obstet Gynecol. Nov 1995;173(5):1384-90.
*Costedoat-Chalumeau N, Amoura Z, Villain E, et al. Anti-SSA/Ro antibodies and the heart: more than complete congenital heart block? A review of electrocardiographic and myocardial abnormalities and of treatment options. Arthritis Res Ther. 2005;7(2):69-73.
*Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, et al. Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. Lupus. 2005;14(9):660-4.
*Cutler NG, Karpawich PP, Cavitt D, et al. Steroid-eluting epicardial pacing electrodes: six year experience of pacing thresholds in a growing pediatric population. Pacing Clin Electrophysiol. Dec 1997;20(12 Pt 1):2943-8.
*Friedman DM, Kim MY, Copel JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation. 2008;117:485-93.
*Friedman DM, Zervoudakis I, Buyon JP. Perinatal monitoring of fetal well-being in the presence of congenital heart block. Am J Perinatol. 1998;15(12):669-73.
*Hamilton R, Gow R, Bahoric B, et al. Steroid-eluting epicardial leads in pediatrics: improved epicardial thresholds in the first year. Pacing Clin Electrophysiol. Nov 1991;14(11 Pt 2):2066-72.
*Hamilton RM, Chiu C, Gow RM, Williams WG. A comparison of two stab-on unipolar epicardial pacing leads in children. Pacing Clin Electrophysiol. Mar 1997;20(3 Pt 1):631-6.
*Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol. Jul 2005;26(1):16-21.
*Karpawich PP, Stokes KB, Proctor K, et al. "In-line" bipolar, steroid-eluting, high impedance, epimyocardial pacing lead. Pacing Clin Electrophysiol. Mar 1998;21(3):503-8.
*Karpawich PP, Walters H, Hakimi M. Chronic performance of a transvenous steroid pacing lead used as an epi- intramyocardial electrode. Pacing Clin Electrophysiol. Jul 1998;21(7):1486-8.
*Miranda-Carus ME, Boutjdir M, Tseng CE. Induction of antibodies reactive with SSA/Ro-SSB/La and development of congenital heart block in a murine model. J Immunol. Dec 1 1998;161(11):5886-92.
*Moak JP, Barron KS, Hougen TJ, et al. Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol. Jan 2001;37(1):238-42.
*Neiman AR, Lee LA, Weston WL, Buyon JP. Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers and children enrolled in a national registry. J Pediatr. Nov 2000;137(5):674-80.
*Rao V, Williams WG, Hamilton RH, et al. Trends in pediatric cardiac pacing. Can J Cardiol. Dec 1995;11(11):993-9.
*Suarez-Penaranda JM, Munoz JI, Rodriguez-Calvo MS, et al. The Pathology of the heart conduction system in congenital heart block. J Clin Forensic Med. Aug-Nov 2006;13(6-8):341-3.
*Weng KP, Chiou CW, Huang SH, et al. The long-term outcome of children with isolated congenital complete atrioventricular block. Acta Paediatr Taiwan. Sep-Oct 2005;46(5):260-7.
{{refend}}

{{Congenital malformations and deformations of circulatory system}}
{{Electrocardiography}}
{{Circulatory system pathology}}
[[Category:Cardiology]]
[[Category:Rheumatology]]
[[Category:Disease]]
[[Category:Congenital disorders]]
[[Category:Developmental biology]]
{{WH}}
{{WS}}

Congenital heart block

2019-08-27T16:19:01Z

Archana Murugan: /* Classification */

__NOTOC__
{{SI}}

'''For patient information page click [[{{PAGENAME}} (patient information)|here]]'''

{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; '''Contributors:''' [[User:Lakeadam|Adam C. Lake]]

==Overview==
Congenital heart block is a rare [[congenital heart disease]] caused by defects in the heart conduction system diagnosed on or before 28 days of life.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
It can lead to [[bradycardia|slowed heart rate]].

==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

==Classification==
*Congenital Heart Block may be classified according to cause into 3 subtypes/groups:
:*Autoimmune
:*Structural
:*Other
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

==Pathophysiology==
Scarring of the conduction system (the heart’s own natural pacemaker), a consequence of [[inflammation]] triggered by the mother’s antibodies, damages or even destroys the cells that allow the heart to beat at a normal rhythm.

[[Neonatal lupus]] (NL) is the name given to a group of conditions that can affect the babies of mothers who have certain [[autoantibody|autoantibodies]] against components of the body’s cells that are called SSA/Ro and SSB/La. Neonatal lupus can appear as a temporary [[rash]] that usually goes away by the time the baby is 6 months old, or very rarely an abnormal blood or [[liver]] condition that also improves with time or it can cause permanent and often life-threatening damage to the fetal heart, known as congenital heart block (CHB). In women with anti-Ro/La antibodies who are pregnant for the first time, only about 2% of the babies will develop congenital heart block. But for a woman who has already had a child with congenital heart block or neonatal lupus rash, the risk of congenital heart block in her next [[pregnancy]] is nearly 20%. Unfortunately, once complete ([[third degree heart block|third degree]]) heart block has been unequivocally identified in a [[fetus]], it has never been reversed with any of the therapies that have been tried to date. If a child is born to a mother with [[lupus]], there is a chance that the child will develop neonatal lupus, especially if the mother is Anti-Ro (SS/A) positive. In the majority of cases, the mother's antibodies will clear from the child in 6 months, however, in a few cases, the affected child will develop complete congenital heart block.

==Causes==
The most common cause of congenital complete heart block is neonatal lupus. It accounts for almost all cases presenting in the intrauterine and neonatal period. Other causes include:
* [[Myocarditis]]
* [[Levo transposition of great arteries]]
* Atrioventricular discordance
* [[Hurler syndrome|Hurler cardiomyopathy]]
* [[Hunter syndrome|Hunter cardiomyopathy]]
* [[Polysplenia]] with atrioventricular canal defect

==Clinical Features==

==Differentiating [disease name] from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:*[Differential dx1]
:*[Differential dx2]
:*[Differential dx3]

==Epidemiology and Demographics==
* The prevalence of congenital heart block is approximately 1 per 22,00 live births individuals worldwide. <ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

===Age===
*Patients of all age groups may develop [disease name].

*[Disease name] is more commonly observed among patients aged [age range] years old.
*[Disease name] is more commonly observed among [elderly patients/young patients/children].

===Gender===
*[Disease name] affects men and women equally.

*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
One form of congenital heart block occurs in babies whose mothers have autoimmune diseases, such as [[SLE|lupus]]. People who have these diseases make proteins called antibodies that attack and damage the body's tissues or cells.

==Natural History, Complications, Prognosis==
===Prognosis===
The damaged heart may beat extremely slowly. In some cases, the heart rate is so slow that it is fatal in nearly 20% of affected babies (with most deaths occurring as [[ fetal demise]]s). Patients presenting as fetuses or at birth have significantly higher morbidity and mortality rates than do patients presenting later in childhood.

*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]

=== Symptoms ===
*Signs and symptoms depend on the type of heart block the child has. [[First-degree heart block]] rarely causes symptoms.
*Symptoms of [[second-degree heart block|second-]] and [[third-degree heart block]] include:
**[[Fainting]]
**[[Dizziness]] or [[light-headedness]]
**[[Fatigue]] ([[tiredness]])
**[[Shortness of breath]]
**[[Chest pain]]

=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*[Imaging study 1] is the imaging modality of choice for [disease name].
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment ==
=== Medical Therapy ===
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.

*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

===Electrocardiogram===
Electrocardiographic findings in congenital heart block depend on the type of block.

==Treatment==
===Surgery===
Treatment depends on the type of heart block.
* [[First-degree heart block]] usually needs no treatment.
* For [[second-degree heart block]], patient may need a [[pacemaker]]. A pacemaker is a small device that's placed under the skin of your chest or [[abdomen]]. This device uses electrical pulses to prompt the heart to beat at a normal rate.
* For [[third-degree heart block]], patient will need a pacemaker.

Nearly all surviving children with congenital heart block require permanent implantation of an [[artificial pacemaker|pacemaker device]].

===Prevention===
Because it is so difficult to treat or repair the damaged heart, a high-priority strategy is to try to prevent the inflammatory process before irreversible scarring can occur. The mother of the child should consult with a rheumatologist to begin monitoring for possible autoimmune disease. Consultation with a rheumatologist is also advised for the infant, particularly if other manifestations of [[neonatal lupus erythematosus]] are present. Genetic consultation is recommended for children with first-degree relatives with structural heart disease or those with storage disorder or [[cardiomyopathy]].

==Source==
* [http://www.clinicaltrials.gov ClinicalTials.gov]

==Related Chapters==
* [[Electrical conduction system of the heart]]
* [[Electrocardiogram]] (ECG or EKG)
* [[SA node]]
* [[AV node]]
* [[Second degree AV block]]
* [[Third degree AV block]]
* [[Bundle branch block]]
* [[Hemiblock]]
* [[Infra-Hisian Block]]
* [[Left anterior fascicular block]]
* [[Left posterior fascicular block]]
* [[Heart block]]
* [[Systemic lupus erythematosus]]
* [[IVIG]]

==References==
{{refbegin|2}}
*Figa FH, McCrindle BW, Bigras JL, et al. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol. Aug 1997;20(8 Pt 1):1902-9.
*Michaelsson M, Jonzon A, Riesenfeld T. Isolated congenital complete atrioventricular block in adult life. A prospective study. Circulation. Aug 1 1995;92(3):442-9. [Full Text].
*Boutjdir M, Chen L, Zhang ZH, et al. Arrhythmogenicity of IgG and anti-52-kD SSA/Ro affinity-purified antibodies from mothers of children with congenital heart block. Circ Res. Mar 1997;80(3):354-62.
*Boutjdir M, Chen L, Zhang ZH, et al. Serum and immunoglobulin G from the mother of a child with congenital heart block induce conduction abnormalities and inhibit L-type calcium channels in a rat heart model. Pediatr Res. Jul 1998;44(1):11-9.
*Claus R, Hickstein H, Kulz T, et al. Identification and management of fetuses at risk for, or affected by, congenital heart block associated with autoantibodies to SSA (Ro), SSB (La), or an HsEg5-like autoantigen. Rheumatol Int. Aug 2006;26(10):886-95.
*Copel JA, Buyon JP, Kleinman CS. Successful in utero therapy of fetal heart block. Am J Obstet Gynecol. Nov 1995;173(5):1384-90.
*Costedoat-Chalumeau N, Amoura Z, Villain E, et al. Anti-SSA/Ro antibodies and the heart: more than complete congenital heart block? A review of electrocardiographic and myocardial abnormalities and of treatment options. Arthritis Res Ther. 2005;7(2):69-73.
*Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, et al. Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. Lupus. 2005;14(9):660-4.
*Cutler NG, Karpawich PP, Cavitt D, et al. Steroid-eluting epicardial pacing electrodes: six year experience of pacing thresholds in a growing pediatric population. Pacing Clin Electrophysiol. Dec 1997;20(12 Pt 1):2943-8.
*Friedman DM, Kim MY, Copel JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation. 2008;117:485-93.
*Friedman DM, Zervoudakis I, Buyon JP. Perinatal monitoring of fetal well-being in the presence of congenital heart block. Am J Perinatol. 1998;15(12):669-73.
*Hamilton R, Gow R, Bahoric B, et al. Steroid-eluting epicardial leads in pediatrics: improved epicardial thresholds in the first year. Pacing Clin Electrophysiol. Nov 1991;14(11 Pt 2):2066-72.
*Hamilton RM, Chiu C, Gow RM, Williams WG. A comparison of two stab-on unipolar epicardial pacing leads in children. Pacing Clin Electrophysiol. Mar 1997;20(3 Pt 1):631-6.
*Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol. Jul 2005;26(1):16-21.
*Karpawich PP, Stokes KB, Proctor K, et al. "In-line" bipolar, steroid-eluting, high impedance, epimyocardial pacing lead. Pacing Clin Electrophysiol. Mar 1998;21(3):503-8.
*Karpawich PP, Walters H, Hakimi M. Chronic performance of a transvenous steroid pacing lead used as an epi- intramyocardial electrode. Pacing Clin Electrophysiol. Jul 1998;21(7):1486-8.
*Miranda-Carus ME, Boutjdir M, Tseng CE. Induction of antibodies reactive with SSA/Ro-SSB/La and development of congenital heart block in a murine model. J Immunol. Dec 1 1998;161(11):5886-92.
*Moak JP, Barron KS, Hougen TJ, et al. Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol. Jan 2001;37(1):238-42.
*Neiman AR, Lee LA, Weston WL, Buyon JP. Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers and children enrolled in a national registry. J Pediatr. Nov 2000;137(5):674-80.
*Rao V, Williams WG, Hamilton RH, et al. Trends in pediatric cardiac pacing. Can J Cardiol. Dec 1995;11(11):993-9.
*Suarez-Penaranda JM, Munoz JI, Rodriguez-Calvo MS, et al. The Pathology of the heart conduction system in congenital heart block. J Clin Forensic Med. Aug-Nov 2006;13(6-8):341-3.
*Weng KP, Chiou CW, Huang SH, et al. The long-term outcome of children with isolated congenital complete atrioventricular block. Acta Paediatr Taiwan. Sep-Oct 2005;46(5):260-7.
{{refend}}

{{Congenital malformations and deformations of circulatory system}}
{{Electrocardiography}}
{{Circulatory system pathology}}
[[Category:Cardiology]]
[[Category:Rheumatology]]
[[Category:Disease]]
[[Category:Congenital disorders]]
[[Category:Developmental biology]]
{{WH}}
{{WS}}

Congenital heart block

2019-08-27T16:05:07Z

Archana Murugan: /* Overview */

__NOTOC__
{{SI}}

'''For patient information page click [[{{PAGENAME}} (patient information)|here]]'''

{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; '''Contributors:''' [[User:Lakeadam|Adam C. Lake]]

==Overview==
Congenital heart block is a rare [[congenital heart disease]] caused by defects in the heart conduction system diagnosed on or before 28 days of life.<ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
It can lead to [[bradycardia|slowed heart rate]].

==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

==Classification==
*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
:*[group1]
:*[group2]
:*[group3]
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

==Pathophysiology==
Scarring of the conduction system (the heart’s own natural pacemaker), a consequence of [[inflammation]] triggered by the mother’s antibodies, damages or even destroys the cells that allow the heart to beat at a normal rhythm.

[[Neonatal lupus]] (NL) is the name given to a group of conditions that can affect the babies of mothers who have certain [[autoantibody|autoantibodies]] against components of the body’s cells that are called SSA/Ro and SSB/La. Neonatal lupus can appear as a temporary [[rash]] that usually goes away by the time the baby is 6 months old, or very rarely an abnormal blood or [[liver]] condition that also improves with time or it can cause permanent and often life-threatening damage to the fetal heart, known as congenital heart block (CHB). In women with anti-Ro/La antibodies who are pregnant for the first time, only about 2% of the babies will develop congenital heart block. But for a woman who has already had a child with congenital heart block or neonatal lupus rash, the risk of congenital heart block in her next [[pregnancy]] is nearly 20%. Unfortunately, once complete ([[third degree heart block|third degree]]) heart block has been unequivocally identified in a [[fetus]], it has never been reversed with any of the therapies that have been tried to date. If a child is born to a mother with [[lupus]], there is a chance that the child will develop neonatal lupus, especially if the mother is Anti-Ro (SS/A) positive. In the majority of cases, the mother's antibodies will clear from the child in 6 months, however, in a few cases, the affected child will develop complete congenital heart block.

==Causes==
The most common cause of congenital complete heart block is neonatal lupus. It accounts for almost all cases presenting in the intrauterine and neonatal period. Other causes include:
* [[Myocarditis]]
* [[Levo transposition of great arteries]]
* Atrioventricular discordance
* [[Hurler syndrome|Hurler cardiomyopathy]]
* [[Hunter syndrome|Hunter cardiomyopathy]]
* [[Polysplenia]] with atrioventricular canal defect

==Clinical Features==

==Differentiating [disease name] from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:*[Differential dx1]
:*[Differential dx2]
:*[Differential dx3]

==Epidemiology and Demographics==
* The prevalence of congenital heart block is approximately 1 per 22,00 live births individuals worldwide. <ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

===Age===
*Patients of all age groups may develop [disease name].

*[Disease name] is more commonly observed among patients aged [age range] years old.
*[Disease name] is more commonly observed among [elderly patients/young patients/children].

===Gender===
*[Disease name] affects men and women equally.

*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
One form of congenital heart block occurs in babies whose mothers have autoimmune diseases, such as [[SLE|lupus]]. People who have these diseases make proteins called antibodies that attack and damage the body's tissues or cells.

==Natural History, Complications, Prognosis==
===Prognosis===
The damaged heart may beat extremely slowly. In some cases, the heart rate is so slow that it is fatal in nearly 20% of affected babies (with most deaths occurring as [[ fetal demise]]s). Patients presenting as fetuses or at birth have significantly higher morbidity and mortality rates than do patients presenting later in childhood.

*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]

=== Symptoms ===
*Signs and symptoms depend on the type of heart block the child has. [[First-degree heart block]] rarely causes symptoms.
*Symptoms of [[second-degree heart block|second-]] and [[third-degree heart block]] include:
**[[Fainting]]
**[[Dizziness]] or [[light-headedness]]
**[[Fatigue]] ([[tiredness]])
**[[Shortness of breath]]
**[[Chest pain]]

=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*[Imaging study 1] is the imaging modality of choice for [disease name].
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment ==
=== Medical Therapy ===
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.

*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

===Electrocardiogram===
Electrocardiographic findings in congenital heart block depend on the type of block.

==Treatment==
===Surgery===
Treatment depends on the type of heart block.
* [[First-degree heart block]] usually needs no treatment.
* For [[second-degree heart block]], patient may need a [[pacemaker]]. A pacemaker is a small device that's placed under the skin of your chest or [[abdomen]]. This device uses electrical pulses to prompt the heart to beat at a normal rate.
* For [[third-degree heart block]], patient will need a pacemaker.

Nearly all surviving children with congenital heart block require permanent implantation of an [[artificial pacemaker|pacemaker device]].

===Prevention===
Because it is so difficult to treat or repair the damaged heart, a high-priority strategy is to try to prevent the inflammatory process before irreversible scarring can occur. The mother of the child should consult with a rheumatologist to begin monitoring for possible autoimmune disease. Consultation with a rheumatologist is also advised for the infant, particularly if other manifestations of [[neonatal lupus erythematosus]] are present. Genetic consultation is recommended for children with first-degree relatives with structural heart disease or those with storage disorder or [[cardiomyopathy]].

==Source==
* [http://www.clinicaltrials.gov ClinicalTials.gov]

==Related Chapters==
* [[Electrical conduction system of the heart]]
* [[Electrocardiogram]] (ECG or EKG)
* [[SA node]]
* [[AV node]]
* [[Second degree AV block]]
* [[Third degree AV block]]
* [[Bundle branch block]]
* [[Hemiblock]]
* [[Infra-Hisian Block]]
* [[Left anterior fascicular block]]
* [[Left posterior fascicular block]]
* [[Heart block]]
* [[Systemic lupus erythematosus]]
* [[IVIG]]

==References==
{{refbegin|2}}
*Figa FH, McCrindle BW, Bigras JL, et al. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol. Aug 1997;20(8 Pt 1):1902-9.
*Michaelsson M, Jonzon A, Riesenfeld T. Isolated congenital complete atrioventricular block in adult life. A prospective study. Circulation. Aug 1 1995;92(3):442-9. [Full Text].
*Boutjdir M, Chen L, Zhang ZH, et al. Arrhythmogenicity of IgG and anti-52-kD SSA/Ro affinity-purified antibodies from mothers of children with congenital heart block. Circ Res. Mar 1997;80(3):354-62.
*Boutjdir M, Chen L, Zhang ZH, et al. Serum and immunoglobulin G from the mother of a child with congenital heart block induce conduction abnormalities and inhibit L-type calcium channels in a rat heart model. Pediatr Res. Jul 1998;44(1):11-9.
*Claus R, Hickstein H, Kulz T, et al. Identification and management of fetuses at risk for, or affected by, congenital heart block associated with autoantibodies to SSA (Ro), SSB (La), or an HsEg5-like autoantigen. Rheumatol Int. Aug 2006;26(10):886-95.
*Copel JA, Buyon JP, Kleinman CS. Successful in utero therapy of fetal heart block. Am J Obstet Gynecol. Nov 1995;173(5):1384-90.
*Costedoat-Chalumeau N, Amoura Z, Villain E, et al. Anti-SSA/Ro antibodies and the heart: more than complete congenital heart block? A review of electrocardiographic and myocardial abnormalities and of treatment options. Arthritis Res Ther. 2005;7(2):69-73.
*Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, et al. Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. Lupus. 2005;14(9):660-4.
*Cutler NG, Karpawich PP, Cavitt D, et al. Steroid-eluting epicardial pacing electrodes: six year experience of pacing thresholds in a growing pediatric population. Pacing Clin Electrophysiol. Dec 1997;20(12 Pt 1):2943-8.
*Friedman DM, Kim MY, Copel JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation. 2008;117:485-93.
*Friedman DM, Zervoudakis I, Buyon JP. Perinatal monitoring of fetal well-being in the presence of congenital heart block. Am J Perinatol. 1998;15(12):669-73.
*Hamilton R, Gow R, Bahoric B, et al. Steroid-eluting epicardial leads in pediatrics: improved epicardial thresholds in the first year. Pacing Clin Electrophysiol. Nov 1991;14(11 Pt 2):2066-72.
*Hamilton RM, Chiu C, Gow RM, Williams WG. A comparison of two stab-on unipolar epicardial pacing leads in children. Pacing Clin Electrophysiol. Mar 1997;20(3 Pt 1):631-6.
*Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol. Jul 2005;26(1):16-21.
*Karpawich PP, Stokes KB, Proctor K, et al. "In-line" bipolar, steroid-eluting, high impedance, epimyocardial pacing lead. Pacing Clin Electrophysiol. Mar 1998;21(3):503-8.
*Karpawich PP, Walters H, Hakimi M. Chronic performance of a transvenous steroid pacing lead used as an epi- intramyocardial electrode. Pacing Clin Electrophysiol. Jul 1998;21(7):1486-8.
*Miranda-Carus ME, Boutjdir M, Tseng CE. Induction of antibodies reactive with SSA/Ro-SSB/La and development of congenital heart block in a murine model. J Immunol. Dec 1 1998;161(11):5886-92.
*Moak JP, Barron KS, Hougen TJ, et al. Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol. Jan 2001;37(1):238-42.
*Neiman AR, Lee LA, Weston WL, Buyon JP. Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers and children enrolled in a national registry. J Pediatr. Nov 2000;137(5):674-80.
*Rao V, Williams WG, Hamilton RH, et al. Trends in pediatric cardiac pacing. Can J Cardiol. Dec 1995;11(11):993-9.
*Suarez-Penaranda JM, Munoz JI, Rodriguez-Calvo MS, et al. The Pathology of the heart conduction system in congenital heart block. J Clin Forensic Med. Aug-Nov 2006;13(6-8):341-3.
*Weng KP, Chiou CW, Huang SH, et al. The long-term outcome of children with isolated congenital complete atrioventricular block. Acta Paediatr Taiwan. Sep-Oct 2005;46(5):260-7.
{{refend}}

{{Congenital malformations and deformations of circulatory system}}
{{Electrocardiography}}
{{Circulatory system pathology}}
[[Category:Cardiology]]
[[Category:Rheumatology]]
[[Category:Disease]]
[[Category:Congenital disorders]]
[[Category:Developmental biology]]
{{WH}}
{{WS}}

Congenital heart block

2019-08-27T16:01:14Z

Archana Murugan: /* Epidemiology and Demographics */

__NOTOC__
{{SI}}

'''For patient information page click [[{{PAGENAME}} (patient information)|here]]'''

{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; '''Contributors:''' [[User:Lakeadam|Adam C. Lake]]

==Overview==
Congenital heart block is a rare [[congenital heart disease]] where a [[bradycardia|slowed heart rate]] is caused by defects in the heart conduction system.

==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

==Classification==
*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
:*[group1]
:*[group2]
:*[group3]
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

==Pathophysiology==
Scarring of the conduction system (the heart’s own natural pacemaker), a consequence of [[inflammation]] triggered by the mother’s antibodies, damages or even destroys the cells that allow the heart to beat at a normal rhythm.

[[Neonatal lupus]] (NL) is the name given to a group of conditions that can affect the babies of mothers who have certain [[autoantibody|autoantibodies]] against components of the body’s cells that are called SSA/Ro and SSB/La. Neonatal lupus can appear as a temporary [[rash]] that usually goes away by the time the baby is 6 months old, or very rarely an abnormal blood or [[liver]] condition that also improves with time or it can cause permanent and often life-threatening damage to the fetal heart, known as congenital heart block (CHB). In women with anti-Ro/La antibodies who are pregnant for the first time, only about 2% of the babies will develop congenital heart block. But for a woman who has already had a child with congenital heart block or neonatal lupus rash, the risk of congenital heart block in her next [[pregnancy]] is nearly 20%. Unfortunately, once complete ([[third degree heart block|third degree]]) heart block has been unequivocally identified in a [[fetus]], it has never been reversed with any of the therapies that have been tried to date. If a child is born to a mother with [[lupus]], there is a chance that the child will develop neonatal lupus, especially if the mother is Anti-Ro (SS/A) positive. In the majority of cases, the mother's antibodies will clear from the child in 6 months, however, in a few cases, the affected child will develop complete congenital heart block.

==Causes==
The most common cause of congenital complete heart block is neonatal lupus. It accounts for almost all cases presenting in the intrauterine and neonatal period. Other causes include:
* [[Myocarditis]]
* [[Levo transposition of great arteries]]
* Atrioventricular discordance
* [[Hurler syndrome|Hurler cardiomyopathy]]
* [[Hunter syndrome|Hunter cardiomyopathy]]
* [[Polysplenia]] with atrioventricular canal defect

==Clinical Features==

==Differentiating [disease name] from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:*[Differential dx1]
:*[Differential dx2]
:*[Differential dx3]

==Epidemiology and Demographics==
* The prevalence of congenital heart block is approximately 1 per 22,00 live births individuals worldwide. <ref>{{Cite journal
| author = [[Dm Friedman]], [[Lj Duncanson]], [[J. Glickstein]] & [[Jp Buyon]]
| title = A review of congenital heart block
| journal = [[Images in paediatric cardiology]]
| volume = 5
| issue = 3
| pages = 36–48
| year = 2003
| month = July
| pmid = 22368629
}}</ref>
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

===Age===
*Patients of all age groups may develop [disease name].

*[Disease name] is more commonly observed among patients aged [age range] years old.
*[Disease name] is more commonly observed among [elderly patients/young patients/children].

===Gender===
*[Disease name] affects men and women equally.

*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
One form of congenital heart block occurs in babies whose mothers have autoimmune diseases, such as [[SLE|lupus]]. People who have these diseases make proteins called antibodies that attack and damage the body's tissues or cells.

==Natural History, Complications, Prognosis==
===Prognosis===
The damaged heart may beat extremely slowly. In some cases, the heart rate is so slow that it is fatal in nearly 20% of affected babies (with most deaths occurring as [[ fetal demise]]s). Patients presenting as fetuses or at birth have significantly higher morbidity and mortality rates than do patients presenting later in childhood.

*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]

=== Symptoms ===
*Signs and symptoms depend on the type of heart block the child has. [[First-degree heart block]] rarely causes symptoms.
*Symptoms of [[second-degree heart block|second-]] and [[third-degree heart block]] include:
**[[Fainting]]
**[[Dizziness]] or [[light-headedness]]
**[[Fatigue]] ([[tiredness]])
**[[Shortness of breath]]
**[[Chest pain]]

=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*[Imaging study 1] is the imaging modality of choice for [disease name].
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment ==
=== Medical Therapy ===
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.

*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

===Electrocardiogram===
Electrocardiographic findings in congenital heart block depend on the type of block.

==Treatment==
===Surgery===
Treatment depends on the type of heart block.
* [[First-degree heart block]] usually needs no treatment.
* For [[second-degree heart block]], patient may need a [[pacemaker]]. A pacemaker is a small device that's placed under the skin of your chest or [[abdomen]]. This device uses electrical pulses to prompt the heart to beat at a normal rate.
* For [[third-degree heart block]], patient will need a pacemaker.

Nearly all surviving children with congenital heart block require permanent implantation of an [[artificial pacemaker|pacemaker device]].

===Prevention===
Because it is so difficult to treat or repair the damaged heart, a high-priority strategy is to try to prevent the inflammatory process before irreversible scarring can occur. The mother of the child should consult with a rheumatologist to begin monitoring for possible autoimmune disease. Consultation with a rheumatologist is also advised for the infant, particularly if other manifestations of [[neonatal lupus erythematosus]] are present. Genetic consultation is recommended for children with first-degree relatives with structural heart disease or those with storage disorder or [[cardiomyopathy]].

==Source==
* [http://www.clinicaltrials.gov ClinicalTials.gov]

==Related Chapters==
* [[Electrical conduction system of the heart]]
* [[Electrocardiogram]] (ECG or EKG)
* [[SA node]]
* [[AV node]]
* [[Second degree AV block]]
* [[Third degree AV block]]
* [[Bundle branch block]]
* [[Hemiblock]]
* [[Infra-Hisian Block]]
* [[Left anterior fascicular block]]
* [[Left posterior fascicular block]]
* [[Heart block]]
* [[Systemic lupus erythematosus]]
* [[IVIG]]

==References==
{{refbegin|2}}
*Figa FH, McCrindle BW, Bigras JL, et al. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol. Aug 1997;20(8 Pt 1):1902-9.
*Michaelsson M, Jonzon A, Riesenfeld T. Isolated congenital complete atrioventricular block in adult life. A prospective study. Circulation. Aug 1 1995;92(3):442-9. [Full Text].
*Boutjdir M, Chen L, Zhang ZH, et al. Arrhythmogenicity of IgG and anti-52-kD SSA/Ro affinity-purified antibodies from mothers of children with congenital heart block. Circ Res. Mar 1997;80(3):354-62.
*Boutjdir M, Chen L, Zhang ZH, et al. Serum and immunoglobulin G from the mother of a child with congenital heart block induce conduction abnormalities and inhibit L-type calcium channels in a rat heart model. Pediatr Res. Jul 1998;44(1):11-9.
*Claus R, Hickstein H, Kulz T, et al. Identification and management of fetuses at risk for, or affected by, congenital heart block associated with autoantibodies to SSA (Ro), SSB (La), or an HsEg5-like autoantigen. Rheumatol Int. Aug 2006;26(10):886-95.
*Copel JA, Buyon JP, Kleinman CS. Successful in utero therapy of fetal heart block. Am J Obstet Gynecol. Nov 1995;173(5):1384-90.
*Costedoat-Chalumeau N, Amoura Z, Villain E, et al. Anti-SSA/Ro antibodies and the heart: more than complete congenital heart block? A review of electrocardiographic and myocardial abnormalities and of treatment options. Arthritis Res Ther. 2005;7(2):69-73.
*Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, et al. Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. Lupus. 2005;14(9):660-4.
*Cutler NG, Karpawich PP, Cavitt D, et al. Steroid-eluting epicardial pacing electrodes: six year experience of pacing thresholds in a growing pediatric population. Pacing Clin Electrophysiol. Dec 1997;20(12 Pt 1):2943-8.
*Friedman DM, Kim MY, Copel JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation. 2008;117:485-93.
*Friedman DM, Zervoudakis I, Buyon JP. Perinatal monitoring of fetal well-being in the presence of congenital heart block. Am J Perinatol. 1998;15(12):669-73.
*Hamilton R, Gow R, Bahoric B, et al. Steroid-eluting epicardial leads in pediatrics: improved epicardial thresholds in the first year. Pacing Clin Electrophysiol. Nov 1991;14(11 Pt 2):2066-72.
*Hamilton RM, Chiu C, Gow RM, Williams WG. A comparison of two stab-on unipolar epicardial pacing leads in children. Pacing Clin Electrophysiol. Mar 1997;20(3 Pt 1):631-6.
*Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol. Jul 2005;26(1):16-21.
*Karpawich PP, Stokes KB, Proctor K, et al. "In-line" bipolar, steroid-eluting, high impedance, epimyocardial pacing lead. Pacing Clin Electrophysiol. Mar 1998;21(3):503-8.
*Karpawich PP, Walters H, Hakimi M. Chronic performance of a transvenous steroid pacing lead used as an epi- intramyocardial electrode. Pacing Clin Electrophysiol. Jul 1998;21(7):1486-8.
*Miranda-Carus ME, Boutjdir M, Tseng CE. Induction of antibodies reactive with SSA/Ro-SSB/La and development of congenital heart block in a murine model. J Immunol. Dec 1 1998;161(11):5886-92.
*Moak JP, Barron KS, Hougen TJ, et al. Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol. Jan 2001;37(1):238-42.
*Neiman AR, Lee LA, Weston WL, Buyon JP. Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers and children enrolled in a national registry. J Pediatr. Nov 2000;137(5):674-80.
*Rao V, Williams WG, Hamilton RH, et al. Trends in pediatric cardiac pacing. Can J Cardiol. Dec 1995;11(11):993-9.
*Suarez-Penaranda JM, Munoz JI, Rodriguez-Calvo MS, et al. The Pathology of the heart conduction system in congenital heart block. J Clin Forensic Med. Aug-Nov 2006;13(6-8):341-3.
*Weng KP, Chiou CW, Huang SH, et al. The long-term outcome of children with isolated congenital complete atrioventricular block. Acta Paediatr Taiwan. Sep-Oct 2005;46(5):260-7.
{{refend}}

{{Congenital malformations and deformations of circulatory system}}
{{Electrocardiography}}
{{Circulatory system pathology}}
[[Category:Cardiology]]
[[Category:Rheumatology]]
[[Category:Disease]]
[[Category:Congenital disorders]]
[[Category:Developmental biology]]
{{WH}}
{{WS}}

Eosinophilic cardiomyopathy

2019-05-07T00:59:32Z

Archana Murugan: /* Prevention */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include [[dyspnea]], [[fever]], and [[chest pain]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop [[heart failure]], [[arrythmias]], and [[sudden cardiac death]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [[Hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated [[eosinophil]] count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a [[bone marrow]] section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Dyspnea]] at rest or on exertion
:*[[Chest pain]]
:*[[Cough]]
:*[[Rash]]
:*[[Malaise]]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Tachycardia]]
:*[[Tachypnea]]
:*[[Arrythmia]]
:*[[Rash]]
:*[[Embolic]] events

=== Laboratory Findings ===

*A positive cardiac [[biopsy]] is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of [[eosinophils]] in [[peripheral blood smear]] is diagnostic of [[Hypereosinophilic syndrome]].<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal [[bone marrow biopsy]], and abnormal [[troponins]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac [[MRI]] is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac [[MRI]], Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*[[Echocardiography]] may demonstrate endomyocardial thickening, ventricular [[thrombus]] formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using [[ECG]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on [[ECG]] include T wave inversion, Left atrial enlargement, [[Left ventricular hypertrophy]], and [[Right bundle branch block]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is [[imatinib]] and [[steroids]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes [[diuretics]], [[Beta Blockers]], [[ACE inhibitors]], [[Angiotensin Receptor Blockers]], and [[Digoxin]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*[[Imatinib]] acts by inhibition of [[tyrosine kinase]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with [[Echocardiography]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*[[Valve replacement]] may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac [[Transplant]] may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes [[Echocardiography]] and [[Electrocardiogram]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:58:31Z

Archana Murugan: /* Surgery */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include [[dyspnea]], [[fever]], and [[chest pain]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop [[heart failure]], [[arrythmias]], and [[sudden cardiac death]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [[Hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated [[eosinophil]] count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a [[bone marrow]] section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Dyspnea]] at rest or on exertion
:*[[Chest pain]]
:*[[Cough]]
:*[[Rash]]
:*[[Malaise]]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Tachycardia]]
:*[[Tachypnea]]
:*[[Arrythmia]]
:*[[Rash]]
:*[[Embolic]] events

=== Laboratory Findings ===

*A positive cardiac [[biopsy]] is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of [[eosinophils]] in [[peripheral blood smear]] is diagnostic of [[Hypereosinophilic syndrome]].<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal [[bone marrow biopsy]], and abnormal [[troponins]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac [[MRI]] is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac [[MRI]], Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*[[Echocardiography]] may demonstrate endomyocardial thickening, ventricular [[thrombus]] formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using [[ECG]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on [[ECG]] include T wave inversion, Left atrial enlargement, [[Left ventricular hypertrophy]], and [[Right bundle branch block]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is [[imatinib]] and [[steroids]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes [[diuretics]], [[Beta Blockers]], [[ACE inhibitors]], [[Angiotensin Receptor Blockers]], and [[Digoxin]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*[[Imatinib]] acts by inhibition of [[tyrosine kinase]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with [[Echocardiography]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*[[Valve replacement]] may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac [[Transplant]] may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:57:43Z

Archana Murugan: /* Medical Therapy */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include [[dyspnea]], [[fever]], and [[chest pain]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop [[heart failure]], [[arrythmias]], and [[sudden cardiac death]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [[Hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated [[eosinophil]] count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a [[bone marrow]] section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Dyspnea]] at rest or on exertion
:*[[Chest pain]]
:*[[Cough]]
:*[[Rash]]
:*[[Malaise]]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Tachycardia]]
:*[[Tachypnea]]
:*[[Arrythmia]]
:*[[Rash]]
:*[[Embolic]] events

=== Laboratory Findings ===

*A positive cardiac [[biopsy]] is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of [[eosinophils]] in [[peripheral blood smear]] is diagnostic of [[Hypereosinophilic syndrome]].<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal [[bone marrow biopsy]], and abnormal [[troponins]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac [[MRI]] is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac [[MRI]], Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*[[Echocardiography]] may demonstrate endomyocardial thickening, ventricular [[thrombus]] formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using [[ECG]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on [[ECG]] include T wave inversion, Left atrial enlargement, [[Left ventricular hypertrophy]], and [[Right bundle branch block]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is [[imatinib]] and [[steroids]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes [[diuretics]], [[Beta Blockers]], [[ACE inhibitors]], [[Angiotensin Receptor Blockers]], and [[Digoxin]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*[[Imatinib]] acts by inhibition of [[tyrosine kinase]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with [[Echocardiography]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:55:38Z

Archana Murugan: /* Other Diagnostic Studies */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include [[dyspnea]], [[fever]], and [[chest pain]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop [[heart failure]], [[arrythmias]], and [[sudden cardiac death]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [[Hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated [[eosinophil]] count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a [[bone marrow]] section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Dyspnea]] at rest or on exertion
:*[[Chest pain]]
:*[[Cough]]
:*[[Rash]]
:*[[Malaise]]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Tachycardia]]
:*[[Tachypnea]]
:*[[Arrythmia]]
:*[[Rash]]
:*[[Embolic]] events

=== Laboratory Findings ===

*A positive cardiac [[biopsy]] is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of [[eosinophils]] in [[peripheral blood smear]] is diagnostic of [[Hypereosinophilic syndrome]].<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal [[bone marrow biopsy]], and abnormal [[troponins]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac [[MRI]] is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac [[MRI]], Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*[[Echocardiography]] may demonstrate endomyocardial thickening, ventricular [[thrombus]] formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using [[ECG]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on [[ECG]] include T wave inversion, Left atrial enlargement, [[Left ventricular hypertrophy]], and [[Right bundle branch block]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:54:25Z

Archana Murugan: /* Imaging Findings */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include [[dyspnea]], [[fever]], and [[chest pain]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop [[heart failure]], [[arrythmias]], and [[sudden cardiac death]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [[Hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated [[eosinophil]] count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a [[bone marrow]] section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Dyspnea]] at rest or on exertion
:*[[Chest pain]]
:*[[Cough]]
:*[[Rash]]
:*[[Malaise]]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Tachycardia]]
:*[[Tachypnea]]
:*[[Arrythmia]]
:*[[Rash]]
:*[[Embolic]] events

=== Laboratory Findings ===

*A positive cardiac [[biopsy]] is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of [[eosinophils]] in [[peripheral blood smear]] is diagnostic of [[Hypereosinophilic syndrome]].<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal [[bone marrow biopsy]], and abnormal [[troponins]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac [[MRI]] is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac [[MRI]], Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*[[Echocardiography]] may demonstrate endomyocardial thickening, ventricular [[thrombus]] formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:52:57Z

Archana Murugan: /* Laboratory Findings */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include [[dyspnea]], [[fever]], and [[chest pain]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop [[heart failure]], [[arrythmias]], and [[sudden cardiac death]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [[Hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated [[eosinophil]] count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a [[bone marrow]] section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Dyspnea]] at rest or on exertion
:*[[Chest pain]]
:*[[Cough]]
:*[[Rash]]
:*[[Malaise]]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Tachycardia]]
:*[[Tachypnea]]
:*[[Arrythmia]]
:*[[Rash]]
:*[[Embolic]] events

=== Laboratory Findings ===

*A positive cardiac [[biopsy]] is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of [[eosinophils]] in [[peripheral blood smear]] is diagnostic of [[Hypereosinophilic syndrome]].<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal [[bone marrow biopsy]], and abnormal [[troponins]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:50:41Z

Archana Murugan: /* Physical Examination */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include [[dyspnea]], [[fever]], and [[chest pain]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop [[heart failure]], [[arrythmias]], and [[sudden cardiac death]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [[Hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated [[eosinophil]] count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a [[bone marrow]] section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Dyspnea]] at rest or on exertion
:*[[Chest pain]]
:*[[Cough]]
:*[[Rash]]
:*[[Malaise]]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Tachycardia]]
:*[[Tachypnea]]
:*[[Arrythmia]]
:*[[Rash]]
:*[[Embolic]] events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:48:37Z

Archana Murugan: /* Symptoms */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include [[dyspnea]], [[fever]], and [[chest pain]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop [[heart failure]], [[arrythmias]], and [[sudden cardiac death]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [[Hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated [[eosinophil]] count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a [[bone marrow]] section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*[[Fever]]
:*[[Dyspnea]] at rest or on exertion
:*[[Chest pain]]
:*[[Cough]]
:*[[Rash]]
:*[[Malaise]]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:47:31Z

Archana Murugan: /* Diagnostic Criteria */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include [[dyspnea]], [[fever]], and [[chest pain]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop [[heart failure]], [[arrythmias]], and [[sudden cardiac death]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of [[Hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated [[eosinophil]] count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a [[bone marrow]] section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:45:34Z

Archana Murugan: /* Natural History, Complications and Prognosis */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include [[dyspnea]], [[fever]], and [[chest pain]].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop [[heart failure]], [[arrythmias]], and [[sudden cardiac death]].<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:44:22Z

Archana Murugan: /* Risk Factors */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:41:40Z

Archana Murugan: /* Risk Factors */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:40:20Z

Archana Murugan: /* Overview */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:36:23Z

Archana Murugan: /* Epidemiology and Demographics */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of Hypereosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:35:00Z

Archana Murugan: /* Differentiating [disease name] from other Diseases */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of Hypereosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* [[Amyloidosis]]<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* [[Sarcoidosis]]<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* [[Hemachromatosis]]<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:33:35Z

Archana Murugan: /* Clinical Features */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of Hypereosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* [[Dyspnea]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Chest pain]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Cough]]<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Embolic]] events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* [[Fever]] <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:32:01Z

Archana Murugan: /* Pathophysiology */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of Hypereosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic [[leukemia]] <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, [[cardiac hypertrophy]] and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, [[hypereosinophilia]], myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-07T00:27:45Z

Archana Murugan: /* Overview */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of [[restrictive cardiomyopathy]] caused by eosinophillic infiltration of the [[endomyocardium]].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural [[thrombi]]/ [[thrombus]] formation
*Stage 3: Fibrotic stage
There are many causes of Hypereosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** [[Eosinophillic Granulomatosis Polyangitis]]<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** [[Autoimmune]] disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-06T04:22:06Z

Archana Murugan: /* Natural History, Complications and Prognosis */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally good, and depends on its etiology.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T22:13:47Z

Archana Murugan: /* Medical Therapy */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with Echocardiography.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T22:10:40Z

Archana Murugan: /* Treatment */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with cardiac biopsy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T22:09:14Z

Archana Murugan: /* Surgery */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with cardiac biopsy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===

*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T22:08:08Z

Archana Murugan: /* Prevention */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with cardiac biopsy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.

*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T21:59:38Z

Archana Murugan: /* Treatment */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to treatment can be monitored with cardiac biopsy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T21:57:40Z

Archana Murugan: /* Laboratory Findings */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T21:53:38Z

Archana Murugan: /* Physical Examination */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T21:52:01Z

Archana Murugan: /* Symptoms */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T21:47:09Z

Archana Murugan: /* Laboratory Findings */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T21:45:10Z

Archana Murugan: /* Differentiating [disease name] from other Diseases */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure<ref>{{Cite journal
| author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
| title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
| journal = [[European journal of heart failure]]
| year = 2019
| month = April
| doi = 10.1002/ejhf.1461
| pmid = 30989768
}}</ref>, such as:
:* Amyloidosis<ref>{{Cite journal
| author = [[Adeyemi Adedamola Taiwo]], [[Lavanya Alapati]] & [[Assad Movahed]]
| title = Cardiac amyloidosis: A case report and review of literature
| journal = [[World journal of clinical cases]]
| volume = 7
| issue = 6
| pages = 742–752
| year = 2019
| month = March
| doi = 10.12998/wjcc.v7.i6.742
| pmid = 30968039
}}</ref>
:* Sarcoidosis<ref>{{Cite journal
| author = [[Jian Liang Tan]] & [[Sandeep K. Sharma]]
| title = Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report
| journal = [[European heart journal. Case reports]]
| volume = 2
| issue = 4
| pages = yty103
| year = 2018
| month = December
| doi = 10.1093/ehjcr/yty103
| pmid = 31020179
}}</ref>
:* Hemachromatosis<ref>{{Cite journal
| author = [[Kristen N.. Brown]] & [[Rene R.. Diaz]]
| title = Restrictive (Infiltrative) Cardiomyopathy
| year = 2019
| month = January
| pmid = 30725919
}}</ref>

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T21:30:25Z

Archana Murugan: /* Natural History, Complications and Prognosis */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure, such as:
:* Amyloidosis
:* Sarcoidosis
:* Hemachromatosis

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>

*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T20:26:46Z

Archana Murugan: /* Imaging Findings */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure, such as:
:* Amyloidosis
:* Sarcoidosis
:* Hemachromatosis

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.

===Imaging Findings===

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T20:20:56Z

Archana Murugan: /* Laboratory Findings */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure, such as:
:* Amyloidosis
:* Sarcoidosis
:* Hemachromatosis

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement, thrombus formation, and [finding 3].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T20:17:23Z

Archana Murugan: /* Symptoms */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure, such as:
:* Amyloidosis
:* Sarcoidosis
:* Hemachromatosis

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Rash
:*Malaise

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, abnormal troponins , and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement, thrombus formation, and [finding 3].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T20:15:14Z

Archana Murugan: /* Diagnosis */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure, such as:
:* Amyloidosis
:* Sarcoidosis
:* Hemachromatosis

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Embolic events

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, abnormal troponins , and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement, thrombus formation, and [finding 3].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T02:51:34Z

Archana Murugan: /* Symptoms */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure, such as:
:* Amyloidosis
:* Sarcoidosis
:* Hemachromatosis

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Embolic events

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, abnormal troponins , and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement, thrombus formation, and [finding 3].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T02:47:39Z

Archana Murugan: /* Epidemiology and Demographics */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure, such as:
:* Amyloidosis
:* Sarcoidosis
:* Hemachromatosis

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Gender===

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Embolic events
:*[symptom 6]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, abnormal troponins , and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement, thrombus formation, and [finding 3].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T02:39:19Z

Archana Murugan: /* Classification */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure, such as:
:* Amyloidosis
:* Sarcoidosis
:* Hemachromatosis

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*[Disease name] is more commonly observed among [elderly patients/young patients/children].

===Gender===
*[Disease name] affects men and women equally.

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Embolic events
:*[symptom 6]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, abnormal troponins , and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement, thrombus formation, and [finding 3].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T02:35:05Z

Archana Murugan: /* Historical Perspective */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure, such as:
:* Amyloidosis
:* Sarcoidosis
:* Hemachromatosis

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*[Disease name] is more commonly observed among [elderly patients/young patients/children].

===Gender===
*[Disease name] affects men and women equally.

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Embolic events
:*[symptom 6]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, abnormal troponins , and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement, thrombus formation, and [finding 3].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T02:25:23Z

Archana Murugan: /* Overview */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Raquel Miriam Ferreira]], [[Pedro Madureira]], [[Teresa Pinho]], [[Elisabete Martins]], [[Sofia Pimenta]] & [[Lucia Costa]]
| title = Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis
| journal = [[Acta reumatologica portuguesa]]
| volume = 43
| issue = 4
| pages = 309–313
| year = 2018
| month = October-December
| pmid = 30641540
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure, such as:
:* Amyloidosis
:* Sarcoidosis
:* Hemachromatosis

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*[Disease name] is more commonly observed among [elderly patients/young patients/children].

===Gender===
*[Disease name] affects men and women equally.

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Embolic events
:*[symptom 6]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, abnormal troponins , and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement, thrombus formation, and [finding 3].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Eosinophilic cardiomyopathy

2019-05-05T02:21:00Z

Archana Murugan: /* Overview */

{{SI}}
{{CMG}}

==Overview==

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.<ref>{{Cite journal
| author = [[M. Arima]] & [[T. Kanoh]]
| title = Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP
| journal = [[Heart (British Cardiac Society)]]
| volume = 81
| issue = 6
| pages = 669–671
| year = 1999
| month = June
| pmid = 10336931
}}</ref> This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Stage 1: Acute necrotic stage
*Stage 2: Mural thrombi/ thrombus formation
*Stage 3: Fibrotic stage
There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:
* Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
** Eosinophillic Granulomatosis Polyangitis<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref><ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref>
** Parasitic Infection
** Autoimmune disorder
** Medication related <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>
* Clonal Myeloid Disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
* Idiopathic Hypereosinophillic Syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Amit Alam]], [[Shankar Thampi]], [[Shahryar G. Saba]] & [[Rita Jermyn]]
| title = Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis
| journal = [[Clinical medicine insights. Case reports]]
| volume = 10
| pages = 1179547617723643
| year = 2017
| month =
| doi = 10.1177/1179547617723643
| pmid = 28890659
}}</ref>

*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

==Classification==
*Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:
:*Reactive<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Clonal myeloid disorder<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
:*Idiopathic hypereosinophillic syndrome <ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref><ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, thrombi formation <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>, restrictive cardiomyopathy<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>, and heart failure <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>.
*The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia <ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>and hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.<ref>{{Cite journal
| author = [[Christopher C. Cheung]], [[Maggie Constantine]], [[Amir Ahmadi]], [[Carolyn Shiau]] & [[Luke Y. C. Chen]]
| title = Eosinophilic Myocarditis
| journal = [[The American journal of the medical sciences]]
| volume = 354
| issue = 5
| pages = 486–492
| year = 2017
| month = November
| doi = 10.1016/j.amjms.2017.04.002
| pmid = 29173361
}}</ref> <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Gustav Mattsson]] & [[Peter Magnusson]]
| title = Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids
| journal = [[BMC cardiovascular disorders]]
| volume = 17
| issue = 1
| pages = 299
| year = 2017
| month = December
| doi = 10.1186/s12872-017-0734-8
| pmid = 29262787
}}</ref>
*On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[A. Angelini]], [[V. Calzolari]], [[G. Thiene]], [[G. M. Boffa]], [[M. Valente]], [[L. Daliento]], [[C. Basso]], [[F. Calabrese]], [[R. Razzolini]], [[U. Livi]] & [[R. Chioin]]
| title = Morphologic spectrum of primary restrictive cardiomyopathy
| journal = [[The American journal of cardiology]]
| volume = 80
| issue = 8
| pages = 1046–1050
| year = 1997
| month = October
| pmid = 9352976
}}</ref>

==Clinical Features==

* Dyspnea<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Chest pain<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Cough<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Embolic events<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* Fever <ref>{{Cite journal
| author = [[Nooreen Hussain]], [[Preeti Patel]], [[Jonathan Yin]], [[Rachael Davis]] & [[Ossama Ikladios]]
| title = A case of Loeffler's endocarditis after initiation of adalimumab
| journal = [[Journal of community hospital internal medicine perspectives]]
| volume = 9
| issue = 1
| pages = 29–32
| year = 2019
| month =
| doi = 10.1080/20009666.2018.1562852
| pmid = 30788072
}}</ref>

==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure, such as:
:* Amyloidosis
:* Sarcoidosis
:* Hemachromatosis

==Epidemiology and Demographics==
* The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>

===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.<ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>
*[Disease name] is more commonly observed among [elderly patients/young patients/children].

===Gender===
*[Disease name] affects men and women equally.

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
| author = [[Jason Gotlib]]
| title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
| journal = [[American journal of hematology]]
| volume = 90
| issue = 11
| pages = 1077–1089
| year = 2015
| month = November
| doi = 10.1002/ajh.24196
| pmid = 26486351
}}</ref>

===Race===
*There is no racial predilection for [disease name].

*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].

==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,
dysplastic eosinophils, and abnormal early myeloid precursors.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Early clinical features include dyspnea, fever, and chest pain.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.<ref>{{Cite journal
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref> <ref>{{Cite journal
| author = [[Peter Valent]], [[Amy D. Klion]], [[Hans-Peter Horny]], [[Florence Roufosse]], [[Jason Gotlib]], [[Peter F. Weller]], [[Andrzej Hellmann]], [[Georgia Metzgeroth]], [[Kristin M. Leiferman]], [[Michel Arock]], [[Joseph H. Butterfield]], [[Wolfgang R. Sperr]], [[Karl Sotlar]], [[Peter Vandenberghe]], [[Torsten Haferlach]], [[Hans-Uwe Simon]], [[Andreas Reiter]] & [[Gerald J. Gleich]]
| title = Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes
| journal = [[The Journal of allergy and clinical immunology]]
| volume = 130
| issue = 3
| pages = 607–612
| year = 2012
| month = September
| doi = 10.1016/j.jaci.2012.02.019
| pmid = 22460074
}}</ref>
:*an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
:*tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
:*marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
| author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
| title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
| journal = [[Medicine]]
| volume = 97
| issue = 11
| pages = e0079
| year = 2018
| month = March
| doi = 10.1097/MD.0000000000010079
| pmid = 29538200
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:
:*Fever
:*Dyspnea at rest or on exertion
:*Chest pain
:*Cough
:*Embolic events
:*[symptom 6]

=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:
:*Fever
:*Tachycardia
:*Tachypnea
:*Arrythmia
:*Rash
:*Embolic events

=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].

*A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.
*An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.
*Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, abnormal troponins , and [abnormal test 3].

===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].

*Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement, thrombus formation, and [finding 3].<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using ECG.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>

== Treatment ==
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.

*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref> <ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>
*Imatinib acts by inhibition of tyrosine kinase.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
| title = Cardiovascular manifestations of hypereosinophilic syndromes
| journal = [[Immunology and allergy clinics of North America]]
| volume = 27
| issue = 3
| pages = 457–475
| year = 2007
| month = August
| doi = 10.1016/j.iac.2007.07.001
| pmid = 17868859
}}</ref>
*Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
| author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
| title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
| journal = [[Circulation]]
| volume = 112
| issue = 12
| pages = e154–e235
| year = 2005
| month = September
| doi = 10.1161/CIRCULATIONAHA.105.167586
| pmid = 16160202
}}</ref>

=== Prevention ===
*There are no primary preventive measures available for [disease name].

*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}