eMedicine Specialties > Cardiology > Valvular Heart Disease

Loeffler Endocarditis: Follow-up

Author: Sohail A Hassan, MD, Cardiologist and Cardiac Electrophysiologist, Eastside Cardiovascular Medicine; Director or Electrophysiology at St John Macomb Hospital; Assistant Professor of Medicine, Wayne State University School of Medicine
Coauthor(s): Viqar Maria, MD, Resident Physician, Department of Internal Medicine, St John Hospital and Medical Center; Henry Kim, MD, MPH, Fellowship Director, Department of Cardiology, Henry Ford Hospital
Contributor Information and Disclosures

Updated: Oct 14, 2008

Follow-up

Further Inpatient Care

Further inpatient care includes serial CBC counts.

Further Outpatient Care

Outpatient follow-up includes close follow-up observation for recurrence of symptoms of heart failure. Serial echocardiograms to evaluate ejection fraction are also helpful for titration of medications.

Prognosis

  • The overall prognosis of patients with Loeffler endocarditis is poor and depends on the location of involvement in the heart.
  • Disease is usually slow in onset, with progression to increasing degrees of right and left heart failure.
  • Sudden death and syncope are not as common as in other causes of restrictive cardiomyopathy.

Miscellaneous

Medicolegal Pitfalls

The disease can be missed on endomyocardial biopsy because of patchy infiltration of the myocardium.

 


More on Loeffler Endocarditis

Overview: Loeffler Endocarditis
Differential Diagnoses & Workup: Loeffler Endocarditis
Treatment & Medication: Loeffler Endocarditis
Follow-up: Loeffler Endocarditis
Multimedia: Loeffler Endocarditis
References

References

  1. Richardson P, McKenna W, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation. Mar 1 1996;93(5):841-2. [Medline].

  2. Loeffler W. Endocarditis parietalis fibroplastica mit Blut-eosinophilie, ein eigenartiges Krankheitshild. Schweiz Med Wochenschr;. 1936;66:817-820.

  3. Oakley CM, Olsen GJ. Eosinophilia and heart disease. Br Heart J. Mar 1977;39(3):233-7. [Medline].

  4. Herzog CA, Snover DC, Staley NA. Acute necrotising eosinophilic myocarditis. Br Heart J. Sep 1984;52(3):343-8. [Medline].

  5. Tonnesen P, Teglbjaerg CS. An "unexpected" fatal case of the hypereosinophilic syndrome. Eur J Respir Dis. Jul 1984;65(5):389-93. [Medline].

  6. Kim CH, Vlietstra RE, Edwards WD, et al. Steroid-responsive eosinophilic myocarditis: diagnosis by endomyocardial biopsy. Am J Cardiol. May 15 1984;53(10):1472-3. [Medline].

  7. Isaka N, Araki S, Shibata M, et al. Reversal of coronary artery occlusions in allergic granulomatosis and angiitis (Churg-Strauss syndrome). Am Heart J. Sep 1994;128(3):609-13. [Medline].

  8. Seshadri S, Narula J, Chopra P. Asymptomatic eosinophilic myocarditis: 2 + 2 = 4 or 5!. Int J Cardiol. Jun 1991;31(3):348-9. [Medline].

  9. Solley GO, Maldonado JE, Gleich GJ, et al. Endomyocardiopathy with eosinophilia. Mayo Clin Proc. Nov 1976;51(11):697-708. [Medline].

  10. Olsen EG, Spry CJ. Relation between eosinophilia and endomyocardial disease. Prog Cardiovasc Dis. Jan-Feb 1985;27(4):241-54. [Medline].

  11. Priglinger U, Drach J, Ullrich R, et al. Idiopathic eosinophilic endomyocarditis in the absence of peripheral eosinophilia. Leuk Lymphoma. Jan 2002;43(1):215-8. [Medline].

  12. Tai PC, Ackerman SJ, Spry CJ, et al. Deposits of eosinophil granule proteins in cardiac tissues of patients with eosinophilic endomyocardial disease. Lancet. Mar 21 1987;1(8534):643-7. [Medline].

  13. Spry CJ, Tai PC, Davies J. The cardiotoxicity of eosinophils. Postgrad Med J. Mar 1983;59(689):147-53. [Medline].

  14. Gleich GJ, Frigas E, Loegering DA, et al. Cytotoxic properties of the eosinophil major basic protein. J Immunol. Dec 1979;123(6):2925-7. [Medline].

  15. Slungaard A, Vercellotti GM, Tran T, et al. Eosinophil cationic granule proteins impair thrombomodulin function. A potential mechanism for thromboembolism in hypereosinophilic heart disease. J Clin Invest. Apr 1993;91(4):1721-30. [Medline].

  16. Cunningham K, Davies RA, Catching J, Veinot JP. Pathologic quiz case: a young woman with eosinophilia and heart failure. Primary hypereosinophilic syndrome with loeffler endocarditis. Arch Pathol Lab Med. Jan 2005;129(1):e29-30. [Medline].

  17. Cools J, DeAngelo DJ, Gotlib J, et al. A tyrosine kinase created by fusion of the PDGFRA and FIP1L1 genes as a therapeutic target of imatinib in idiopathic hypereosinophilic syndrome. N Engl J Med. Mar 27 2003;348(13):1201-14. [Medline].

  18. Vandenberghe P, Wlodarska I, Michaux L, et al. Clinical and molecular features of FIP1L1-PDFGRA (+) chronic eosinophilic leukemias. Leukemia. Apr 2004;18(4):734-42. [Medline].

  19. Rotoli B, Catalano L, Galderisi M, et al. Rapid reversion of Loeffler's endocarditis by imatinib in early stage clonal hypereosinophilic syndrome. Leuk Lymphoma. Dec 2004;45(12):2503-7. [Medline].

  20. Alderman EL. Non-infective endocardial disease. In: Cardiovascular Disease. 1999:1-7.

  21. Bestetti RB, Corbucci HA, Fornitano LD, et al. Angina-like chest pain and syncope as the clinical presentation of left ventricular endomyocardial fibrosis: a case report. Angiology. May-Jun 2005;56(3):339-42. [Medline].

  22. Weller PF, Bubley GJ. The idiopathic hypereosinophilic syndrome. Blood. May 15 1994;83(10):2759-79. [Medline].

  23. Maruyoshi H, Nakatani S, Yasumura Y, Hanatani A, Yamaguchi T, Yutani C, et al. Löffler's endocarditis associated with unusual ECG change mimicking posterior myocardial infarction. Heart Vessels. Mar 2003;18(1):43-6. [Medline].

  24. Mor A, Segev A, Hershkovits R, et al. Hypereosinophilic syndrome presenting as acute myocardial infarction. Allergy. Sep 2000;55(9):899-900. [Medline].

  25. Gudmundsson GS, Ohr J, Leya F, et al. An unusual case of recurrent Loffler endomyocarditis of the aortic valve. Arch Pathol Lab Med. May 2003;127(5):606-9. [Medline].

  26. Parrillo JE. Heart disease and the eosinophil. N Engl J Med. Nov 29 1990;323(22):1560-1. [Medline].

  27. Spyrou N, Foale R. Restrictive cardiomyopathies. Curr Opin Cardiol. May 1994;9(3):344-8. [Medline].

  28. Child JS, Perloff JK. The restrictive cardiomyopathies. Cardiol Clin. May 1988;6(2):289-316. [Medline].

  29. Watanabe K, Tournilhac O, Camilleri LF. Recurrent thrombosis of prosthetic mitral valve in idiopathic hypereosinophilic syndrome. J Heart Valve Dis. May 2002;11(3):447-9. [Medline].

  30. Paydar A, Ordovas KG, Reddy GP. Magnetic resonance imaging for endomyocardial fibrosis. Pediatr Cardiol. Sep 2008;29(5):1004-5. [Medline].

  31. Arnold M, McGuire L, Lee JC. Loeffler's fibroplastic endocarditis. Pathology. Jan 1988;20(1):79-82. [Medline].

  32. Fawzy ME, Ziady G, Halim M, et al. Endomyocardial fibrosis: report of eight cases. J Am Coll Cardiol. Apr 1985;5(4):983-8. [Medline].

  33. Felice PV, Sawicki J, Anto J. Endomyocardial disease and eosinophilia. Angiology. Nov 1993;44(11):869-74. [Medline].

  34. Uetsuka Y, Kasahara S, Tanaka N, et al. Hemodynamic and scintigraphic improvement after steroid therapy in a case with acute eosinophilic heart disease. Heart Vessels Suppl. 1990;5:8-12. [Medline].

  35. Butterfield JH, Gleich GJ. Interferon-alpha treatment of six patients with the idiopathic hypereosinophilic syndrome. Ann Intern Med. Nov 1 1994;121(9):648-53. [Medline].

  36. Tanaka H, Kawai H, Tatsumi K, Kataoka T, Onishi T, Yokoyama M, et al. Surgical treatment for Loffler's Endocarditis with left ventricular thrombus and severe mitral regurgitation: a case report. J Cardiol. April, 2006;47 (4):207-13. [Medline].

  37. Jategaonkar S, Butz T, Faber L. [Surgical treatment of the hypereosinophilic syndrome with cardiac involvement (Löffler's endocarditis)]. Dtsch Med Wochenschr. Mar. 2007;7133(12):50-52. [Medline].

  38. Braunwald E, Zipes DP, Libby P, eds. Heart Disease: A Textbook of Cardiovascular Medicine. 2001. 6th ed. WB Saunders Co.

  39. Del Giudice P, Desalvador F, Bernard E, Caumes E, Vandenbos F, Marty P, et al. Loeffler's syndrome and cutaneous larva migrans: a rare association. Br J Dermatol. Aug 2002;147(2):386-8. [Medline].

  40. deMello DE, Liapis H, Jureidini S, et al. Cardiac localization of eosinophil-granule major basic protein in acute necrotizing myocarditis. N Engl J Med. Nov 29 1990;323(22):1542-5. [Medline].

  41. Fauci AS, Harley JB, Roberts WC, et al. NIH conference. The idiopathic hypereosinophilic syndrome. Clinical, pathophysiologic, and therapeutic considerations. Ann Intern Med. Jul 1982;97(1):78-92. [Medline].

  42. [Best Evidence] Flood-Page P, Swenson C, Faiferman I, Matthews J, Williams M, Brannick L, et al. A study to evaluate safety and efficacy of mepolizumab in patients with moderate persistent asthma. Am J Respir Crit Care Med. Dec 1 2007;176(11):1062-71. [Medline].

  43. Garrett JK, Jameson SC, Thomson B, Collins MH, Wagoner LE, Freese DK, et al. Anti-interleukin-5 (mepolizumab) therapy for hypereosinophilic syndromes. J Allergy Clin Immunol. Jan 2004;113(1):115-9. [Medline].

  44. Genovesi-Ebert A, Lombardi M, Capochiani E, et al. Heart involvement in T cell lymphoma through hypereosinophilic syndrome: a common complication of a rare condition. J Cardiovasc Magn Reson. 2005;7(2):495-9. [Medline].

  45. Gottdiener JS, Maron BJ, Schooley RT, et al. Two-dimensional echocardiographic assessment of the idiopathic hypereosinophilic syndrome. Anatomic basis of mitral regurgitation and peripheral embolization. Circulation. Mar 1983;67(3):572-8. [Medline].

  46. Hayashi S, Furuya S, Imamura H. Fulminant eosinophilic endomyocarditis in an asthmatic patient treated with pranlukast after corticosteroid withdrawal. Heart. Sep 2001;86(3):E7. [Medline].

  47. Mepolizumab: 240563, anti-IL-5 monoclonal antibody - GlaxoSmithKline, anti-interleukin-5 monoclonal antibody - GlaxoSmithKline, SB 240563. Drugs R D. 2008;9(2):125-30. [Medline].

  48. Ohnishi T, Kita H, Weiler D, et al. IL-5 is the predominant eosinophil-active cytokine in the antigen- induced pulmonary late-phase reaction. Am Rev Respir Dis. Apr 1993;147(4):901-7. [Medline].

Further Reading

Keywords

Loeffler's endocarditis, endomyocardial fibrosis, Loeffler disease, Loeffler syndrome, restrictive cardiomyopathy, eosinophilia, eosinophilic myocarditis, thromboembolism, acute heart failure, hypereosinophilic syndrome, eosinophilic leukemia, eosinophilic endocardial disease, eosinophilic arteritis, myocarditis, eosinophilic endomyocardial disease, idiopathic eosinophilic endomyocarditis, hypereosinophilic syndrome, HES, posterior myocardial infarction, acute myocardial infarction, aortic valve regurgitation secondary to valve fibrosis and fibrotic vegetations on the aortic valve, amyloidosis, eosinophilic proliferation, peripheral eosinophilia, Loeffler endocarditis

Contributor Information and Disclosures

Author

Sohail A Hassan, MD, Cardiologist and Cardiac Electrophysiologist, Eastside Cardiovascular Medicine; Director or Electrophysiology at St John Macomb Hospital; Assistant Professor of Medicine, Wayne State University School of Medicine
Sohail A Hassan, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, Heart Rhythm Society, and Michigan State Medical Society
Disclosure: Medtronic, St Jude's Medical, Boston Scientific Honoraria Speaking and teaching

Coauthor(s)

Viqar Maria, MD, Resident Physician, Department of Internal Medicine, St John Hospital and Medical Center
Viqar Maria, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Henry Kim, MD, MPH, Fellowship Director, Department of Cardiology, Henry Ford Hospital
Henry Kim, MD, MPH is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Hanumant Deshmukh, MD †, Former Chief of Cardiology, Veterans Affairs Medical Center; Former Associate Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Marschall S Runge, MD, PhD, Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, University of North Carolina at Chapel Hill School of Medicine
Marschall S Runge, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Southern Society for Clinical Investigation, and Texas Medical Association
Disclosure: Pfizer Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Orthoclinica Diagnostica Consulting fee Consulting

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

W Robert Taylor, MD, PhD, Professor of Medicine, Division of Cardiology, Emory University; Professor of Biomedical Engineering, The Wallace H Coulter Department of Biomedical Engineering, Georgia Tech and Emory University; Consulting Staff, Department of Cardiology, Atlanta Veterans Affairs Medical Center and Emory University Hospital
W Robert Taylor, MD, PhD is a member of the following medical societies: American Heart Association, American Medical Association, American Physiological Society, and American Society of Echocardiography
Disclosure: Novartis Grant/research funds Other; Sankyo  Grant/research funds Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.