Hypereosinophilic syndrome masquerading as a myocardial infarction causing decompensated heart failure.
BACKGROUND
An 81 year old female patient diagnosed with a chronic low grade hypereosinophilic syndrome presented with angina and dyspnoea.


METHODS
She was managed for a non-ST elevated myocardial infarction since her troponin levels were elevated. On day 5, she suffered an acute clinical deterioration with type I respiratory failure and cardiogenic shock, accompanied by deterioration in left ventricular systolic function demonstrated on echocardiography, and this coincided with a marked rise in eosinophil count. Secondary causes of eosinophilia were excluded permitting a diagnosis of Hypereosinophilic Syndrome (HES) to be made. Coronary angiography revealed unobstructed arteries. Supportive treatment for heart failure included diuretic and inotropes but she dramatically improved both clinically and echocardiographically upon commencement of high dose steroids and hydroxycarbamide. Cardiac magnetic resonance imaging (CMR) demonstrated diffuse, shallow endomyocardial enhancement with late gadolinium, consistent with a diagnosis of eosinophilic myocarditis.


CONCLUSIONS
Hypereosinophilic Syndrome can masquerade as a myocardial infarction causing decompensated heart failure. Early recognition and treatment with steroids can improve outcome.
Wiltshire Cardiac Centre, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK. steve.ramcharitar@chem.ox.ac.uk.
Joanna
J
Lim
Alexander
A
Sternberg
Nathan
N
Manghat
Steve
S
Ramcharitar
D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000150:complications* / Q000175:diagnosis*; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*