Loeffler endocarditis is a form of heart disease characterized by a stiffened, poorly-functioning heart caused by infiltration of the heart by white blood cells known as eosinophils.[1] Restrictive cardiomyopathy is a disease of the heart muscle which results in impaired diastolic filling of the heart ventricles, i.e. the large heart chambers which pump blood into the pulmonary or systemic circulation. Diastole is the part of the cardiac contraction-relaxation cycle in which the heart fills with venous blood after the emptying done during its previous systole (i.e. contraction).[2]
An eosinophil-based specific type of heart damage was first described by the Swiss doctor, Wilhelm Loeffler, in 1936.[3][4] As initially described, the disorder manifests as a restrictive cardiomyopathy, i.e. a poorly expanding and contracting rigid heart that was infiltrated with eosinophils and showed replacement of heart cells by stiff fibrotic connective tissue.[5]
Loeffler endocarditis is now regarded as a manifestation of eosinophilic myocarditis, a disorder that involves the infiltration of the heart's muscular layer by eosinophils that leads to three progressive clinical stages. The first stage involves acute inflammation and subsequent death of heart muscle cells. This stage is dominated by signs and symptoms of the acute coronary syndrome such as angina, heart attack, and congestive heart failure. In the second stage, the endocardium (i.e. interior wall) of the heart forms blood clots which break off and then travel through and block various arteries; this clotting stage may dominate the initial presentation in some individuals. The third stage is a fibrotic stage, i.e. Loeffler endocarditis, wherein scarring replaces damaged heart muscle tissue to cause a poorly contracting heart and/or heart valve disease. Recent publications commonly refer to Loeffler endocarditis as a historical term for the third stage of eosinophilic myocarditis.[5][6][7]
^Loeffler Endocarditis at eMedicine
^"Cardiomyopathy | National Heart, Lung, and Blood Institute (NHLBI)".
^synd/582 at Who Named It?
^Löffler, W. (1936). "Endocarditis parietalis fibroplastica mit Bluteosinophilie. Ein eigenartiges Krankheitsbild" [Endocarditis parietal fibroplastica with eosinophilia. A strange disease]. Schweizerische medizinische Wochenschrift (in German). 66: 817–20.
^ abCheung CC, Constantine M, Ahmadi A, Shiau C, Chen LY (November 2017). "Eosinophilic Myocarditis". The American Journal of the Medical Sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. S2CID 205476783.
^Diny NL, Rose NR, Čiháková D (2017). "Eosinophils in Autoimmune Diseases". Frontiers in Immunology. 8: 484. doi:10.3389/fimmu.2017.00484. PMC 5406413. PMID 28496445.
^Li H, Dai Z, Wang B, Huang W (2015). "A case report of eosinophilic myocarditis and a review of the relevant literature". BMC Cardiovascular Disorders. 15: 15. doi:10.1186/s12872-015-0003-7. PMC 4359588. PMID 25887327.
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