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1. LOEFFLER’S
EOSINOPHILIC
ENDOCARDITIS

2. DEFINITION
Restrictive
Cardiomyopathy
Eosinophilia
( > 120×10ᶺ9/L)
 Disease of the heart muscle
 Impaired ventricular filling
 Diastolic volume is NORMAL or
INCREASED
 Affects ONE or BOTH ventricles

3. stage of manifestation Pathologic specimens Clinical manifestations
Necrotic stage (early
stage)
Eosinophilic myocarditis
Endomyocardial fibrosis
Hypereosinophilia:
• Fever, Sweating, Weight loss, Cough, Rash,
Chest pain, Lymphadenopathy, Splenomegaly
Acute carditis:
 Anorexia, Weight loss, cough, Pulmonary
infiltrates, Skin and retinal lesion, AV valve
regurgitation, Biventricular failure,
Polymorphic ventricular tachycardia
Thrombotic stage Clinical manifestations of
thromboembolism
Thrombotic emboli:
 Cerebral, splenic, renal, and coronary
infarction, Splinter hemorrhages
Fibrotic stage (late
stage)
Acute Heart Failure Restrictive myopathy :
 AV valvular regurgitation,
Kussmall sign, elevated jugular venous
pressure, pulmonary edema, murmur of mitral
regurgitation

4. ETIOLOGY
hypereos
inophilia
allergies
parasitic and
protozoal
infections
malignancy +
idiopathic
autoimmune
diseases

5. ACCOMPANIED BY:
Hyper eosinophilic syndrome
Eosinophilic leukemia
Carcinoma
Lymphoma
Drug reactions
Parasites

6. GROSS APPEARANCE OF ENDOCARDIUM
• Normal heart • Dense fibrosis of ventricles
and valve movement

7. PATHOGENESIS
Eosinophilic
penetration
• Degranulation of
basic proteins
• Cytotoxic effects
inhibiting
multiple enzyme
Fibrotic thickening of
portions of heart
• Cationic proteins +
anionic endothelium
• Endothelial and
myocyte damage
Large mural
thrombi
• Impaired
anticoagulatio
n activity
• ↑ endocardial
thrombus

8. LABORATORY INVESTIGATIONS
1.Complete blood count - eosinophilia
2.Cytogenetics – FISH
3.Molecular analysis – FIP1L1-PDGFRA
fusion gene
4.Percutaneous Endomyocardial Biopsy -
collagen

9. IMAGING
1.ECG
2.ECHOCARDIOGRAPHY
3.CT and MRI

10. PHARMACOLOGICAL MANAGEMENT
Group of drugs Comments
Diuretics, Cardiac Glycosides, ACE
Inhibitors
Heart failure drugs for symptomatic relief
Tyrosine Kinase Inhibitors Imanitib – inhibits cell proliferation
Anti IL5 monoclonal AB Mepolizumab – inhibit
production/activation/
maturation of eosinophils
Antineoplastic and Antimetabolites Hydroxyurea – inhibit cell growth and
proliferation
Corticosteroids Methylprednisolone – anti-inflammatory
drugs
Interferon therapy Interferon alpha 2B

11. SURGICAL MANAGEMENT
Endocardioectomy

12. FOLLOW UP
Complete blood count
Echocardiography

13. DIFFERENTIAL DIAGNOSIS
1. Cardiac Neoplasms
2. Cardiomyopathies
PROGNOSIS
Poor

14. CAROL TAFADZWA DZORANI 631D