Loefflers Endocarditis
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Transcript of Loefflers Endocarditis
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LOEFFLER’S EOSINOPHILICENDOCARDITIS
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DEFINITION
RestrictiveCardiomyopathy
Eosinophilia( > 120×10ᶺ9/L)
Disease of the heart muscle Impaired ventricular filling Diastolic volume is NORMAL or
INCREASED Affects ONE or BOTH ventricles
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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
thromboembolismThrombotic 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
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ETIOLOGY
hypereosinophilia
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ACCOMPANIED BY:
Hyper eosinophilic syndromeEosinophilic leukemia
CarcinomaLymphoma
Drug reactions Parasites
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GROSS APPEARANCE OF ENDOCARDIUM
• Normal heart • Dense fibrosis of ventricles and valve movement
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PATHOGENESIS
Eosinophilic penetration• Degranulation
of basic proteins
• Cytotoxic effects inhibiting multiple enzyme systems
Fibrotic thickening of portions of heart• Cationic
proteins + anionic endothelium
• Endothelial and myocyte damage
Large mural thrombi• Impaired
anticoagulation activity
• ↑ endocardial thrombus formation
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LABORATORY INVESTIGATIONS
1.Complete blood count - eosinophilia
2.Cytogenetics – FISH3.Molecular analysis – FIP1L1-
PDGFRA fusion gene4.Percutaneous Endomyocardial
Biopsy - collagen
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IMAGING
1.ECG2.ECHOCARDIOGRAPHY3.CT and MRI
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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
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SURGICAL MANAGEMENT
Endocardioectomy
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FOLLOW UP
Complete blood count Echocardiography
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DIFFERENTIAL DIAGNOSIS
1. Cardiac Neoplasms2. Cardiomyopathies
PROGNOSISPoor
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CAROL TAFADZWA DZORANI 631D