Unusual cardiac manifestation of hypereosinophilic syndrome

Abstract

Hypereosinophilic syndrome was diagnosed in a 14 year old girl who presented with recurrent syncope. An ambulatory electrocardiogram revealed intermittent type 2 second degree left atrioventricular (AV) block. Focal thinning of the interventricular septum was noted on echocardiography, contrary to the commoner finding of regional ventricular wall thickening among patients with hypereosinophilic syndrome. High grade AV block as a manifestation of hypereosinophilic syndrome is rare and focal thinning of the left ventricle as a manifestation of the syndrome has not been described earlier.

Loeffler’s Endocarditis and Hypereosinophilic Syndrome

“…35,55 A comprehensive laboratory workup consists of blood chemistries of liver, pulmonary and renal function tests, cardiac enzyme levels, abdominal and chest computerized tomography, echocardiogram, electrocardiogram (ECG), cardiac magnetic resonance imaging (CMR), and tissue biopsies. [56][57][58] Specific biomarkers, such as vitamin B12 and tryptase, are currently being analyzed for their positive and negative predictive values in confirming a diagnosis of Loeffler's endocarditis. The clinical heterogeneity of HES allows it to be a difficult disorder to understand; only certain underlying causes have been relatively easy to detect, such as the lymphocytic variant HES and myeloproliferative HES (chronic eosinophilic leukemia).…”

Cardiovascular Manifestations of Hypereosinophilic Syndromes

“…Other reported electrocardiogram abnormalities include ventricular premature complexes, poor R wave progression, nonspecific S-T and T wave abnormalities, and first degree atrioventricular block [3]. There is a single case report of an HES patient presenting with second degree atrioventricular block [28]. In general, electrocardiography is a screening tool that detects changes related to the underlying cardiac pathology in HES, especially left ventricular hypertrophy, but does not reveal any abnormalities that are specific for HES.…”

Idiopathic Hypereosinophilic Syndrome Associated with Multiple Intracardiac Thrombi

“…[1][2][3][4][5] Unusual manifestation of this syndrome such as aortic valve involvement and high-grade AV block have also been reported. 4,6 In reported series, anticoagulant therapy together with steroids is usually advised when thrombus is encountered in this syndrome. But there is no consensus about this approach.…”

“…Instead, echocardiography is valuable in detecting intracardiac thrombi, thickening of the posterior mitral leaflet or the posterior wall, and increases in endomyocardial echodensity in the area of fibrosis 1–5 . Unusual manifestation of this syndrome such as aortic valve involvement and high‐grade AV block have also been reported 4,6 …”