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(Circulation. 2007;115:e614-e616.)
© 2007 American Heart Association, Inc.

Images in Cardiovascular Medicine

Eosinophilic Heart Disease in Acute Myeloproliferative Disorder

Christina S. Reuss, MD; Susan Wilansky, MD

From the Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Scottsdale, Ariz.

Correspondence to Christina S. Reuss, MD, Mayo Clinic Arizona, 13400 E Shea Blvd/3A, Scottsdale, AZ 85260.

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 34-year-old man with no past medical history presented to our emergency department with facial droop and dysarthria. He had a 1-day history of dyspnea and nonproductive cough, which he attributed to a viral illness. Examination was notable only for the neurological abnormalities in the chief complaint, which resolved during the emergency department evaluation. A 12-lead ECG showed sinus tachycardia, a prolonged corrected QT interval (530 ms), and T-wave inversion suggestive of ischemia (Figure 1). MRI of the brain was negative for acute stroke. Laboratory values were notable for a hemoglobin of 8.8 g/dL, white blood cell count of 75 400 cells/mL with absolute eosinophilia to 22 620 cells/mL, and a platelet count of 31 000/mL. Troponin T was elevated to 0.40 µg/mL (normal <0.03) with a normal creatine kinase of 22 U/L. An urgent transthoracic echocardiogram demonstrated a mildly reduced ejection fraction (45%) with apical akinesis. A large echogenic mass with a mobile component consistent with thrombus obliterated the apices of the left and right ventricles (online-only supplementary Movie I; Figure 2). The clinical findings were a transient ischemic attack, leukocytosis with eosinophilia, thrombocytopenia, anemia, and eosinophilic heart disease.

View larger version (83K):   Figure 1. Twelve-lead ECG on admission. Note T-wave inversions in the inferior and precordial leads.

View larger version (66K):   Figure 2. Still-frame echocardiographic image in diastole (A) and systole (B). Hyperechoic mass fills the left ventricular apex, which is consistent with thrombus. The apex is akinetic, yet there is still thrombus in areas of normokinesia.

The patient was treated with leukapheresis, . . . [Full Text of this Article]