EOSINO-FEEL-YA HEART BEAT FAST: A CASE OF VENTRICULAR TACHYCARDIA DUE TO EOSINOPHILIC MYOCARDITIS
Background: Eosinophilic myocarditis (EM) is a rare form of myocardial inflammation characterized by a predominantly eosinophilic infiltrate. The clinical presentation can vary, but EM is often fatal with a high in hospital mortality. Case: A 63 year old Caucasian male with a history of angioimmunoblastic T- cell lymphoma and subsequent hypereosinophilic syndrome (HES) presented with sudden onset of lightheadedness. The patient was found to be in pulsatile monomorphic sustained ventricular tachycardia (VT). He underwent cardioversion and initiation of amiodarone therapy. Labs demonstrated peripheral hypereosinophilia of 32% and pancytopenia. Cardiac MRI demonstrated a large area of organized fibrotic thrombus in the right and left ventricular (LV) apex consistent with his clinical HES along with a preserved LV ejection fraction. Decision-making: Amiodarone was initiated immediately and load commenced during his hospital stay. Glucocorticoids are the initial therapy of choice in this clinical scenario and they were promptly initiated. The strategy of defibrillator implantation in the setting of sustained ventricular arrhythmia due to myocarditis is not routine. Due to the possibility of cardiac fibrotic recovery with therapy and his pancytopenia, it was recommended that the patient undergo prolonged steroid therapy, oncology guided chemotherapy, with reassessment of his endomyocardium in 4-6 weeks. Guided by the observational registry of the AVID trial and the European guidelines, he was discharged with a LifeVest for secondary prevention. He also left on amiodarone along with therapeutic enoxaparin. Conclusion: This case demonstrates a clinical presentation of HES and the myocardial complications of thrombus formation, fibrosis and subsequent VT. It also illustrates the utility of a LifeVest in patients with transient conditions for which recovery is possible.
Published In/Presented At
Caruso, M., Mehta, N., Saqi, B., Rajeswaran, Y., & Martinez, M. (2020, March). EOSINO-FEEL-YA HEART BEAT FAST: A CASE OF VENTRICULAR TACHYCARDIA DUE TO EOSINOPHILIC MYOCARDITIS. Presented at: ACC World Congress of Cardiology, Virtual.
Cardiology | Medicine and Health Sciences
Department of Medicine, Cardiology Division, Department of Medicine Faculty, Department of Medicine Fellows and Residents, Fellows and Residents