Wiltshire Cardiac Centre, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK.
BMC Cardiovasc Disord. 2013 Sep 21;13:75. doi: 10.1186/1471-2261-13-75.
An 81 year old female patient diagnosed with a chronic low grade hypereosinophilic syndrome presented with angina and dyspnoea.
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.
Hypereosinophilic Syndrome can masquerade as a myocardial infarction causing decompensated heart failure. Early recognition and treatment with steroids can improve outcome.
一位 81 岁的女性患者被诊断为慢性低度嗜酸性粒细胞综合征，表现为心绞痛和呼吸困难。
由于肌钙蛋白升高，她被诊断为非 ST 段抬高型心肌梗死。第 5 天，她出现急性临床恶化，表现为 I 型呼吸衰竭和心源性休克，同时超声心动图显示左心室收缩功能恶化，嗜酸性粒细胞计数显著升高。排除了嗜酸性粒细胞增多的继发原因，从而做出嗜酸性粒细胞综合征（HES）的诊断。冠状动脉造影显示动脉无阻塞。心力衰竭的支持性治疗包括利尿剂和正性肌力药物，但在开始使用大剂量类固醇和羟基脲后，她的临床和超声心动图均显著改善。心脏磁共振成像（CMR）显示弥漫性、浅层心内膜增强，伴有晚期钆增强，符合嗜酸性粒细胞性心肌炎的诊断。
嗜酸性粒细胞综合征可伪装为心肌梗死导致心力衰竭失代偿。早期识别和类固醇治疗可改善预后。
