5th International Conference on Heart and Cardiovascular Diseases

Shraddha Ranjan is a medical professional affiliated with Medanta Hospital, Kankarbagh, Patna, India. Her clinical interests include Echocardiography, with a focus on cardiac imaging and the assessment of cardiovascular structure and function.

Loeffler’s endocarditis also known as eosinophilic endocarditis is a rare form of restrictive cardiomyopathy where there is infiltration, inflammation and subsequent fibrosis of endocardium mostly involving the apical part of ventricles.A 32-year-old man presented with cough and shortness of breath from almost two years along with development of orthopnea and pedal edema from last two months. He was diagnosed at local hospital as rheumatic heart disease with severe mitral regurgitation (MR) and was referred to our CTVS department for mitral valve replacement.Transthoracic echocardiography (TTE) showed bi-atrial enlargement with normal right and left ventricle size and systolic function. There was biventricular echogenic mass obliterating both apices. The posterolateral LV wall was echogenic with fibrosis and tethering of posterior mitral leaflet causing severe MR. This appearance of restricted and fibrotic PML may have caused confusion as the aetiology being rheumatic. Mitral inflow pattern showed a marked restrictive LV filling. Moderate low pressure tricuspid regurgitation was present with dilated non-collapsing IVC.3D TTE and CMR gave additional information about the cavity obliteration and extent of fibrosis. Biochemistry showed TLC of 17,930 with 63 % eosinophils and diagnosis of HES was made after ruling out other causes of eosinophilia. He was started on steroids, antihelminthic and diuretics but didn’t show much symptomatic improvement, neither his eosinophils decreased after 3 weeks.Genetic testing came out to be FIPL1-PDGFRA positive proving monoclonality following which he was started on imatinib. After one month of treatment his eosinophils decreased drastically to less than 1%. His echocardiographic features of RCMP and his symptoms showed modest improvement, manageable with medical management.Loefflers endocarditis is a disease with poor prognosis if diagnosed later, so early etiological diagnosis can change the course of disease.