Brown Chris, Henry John A, Le Page Pierre, Mitchell Andrew R
Department of Cardiology, Jersey General Hospital, Gloucester Street, St. Helier, JE1 3QS, Jersey.
Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.
Eur Heart J Case Rep. 2024 Oct 22;8(11):ytae569. doi: 10.1093/ehjcr/ytae569. eCollection 2024 Nov.
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare vasculitis associated with significant cardiac morbidity and mortality. This case report presents the diagnostic and management challenges of EGPA-related arrhythmias in a remote general hospital setting.
A 64-year-old Caucasian male presented with an indolent prodrome of fatigue, shortness of breath and anorexia, that culminated in an acute presentation with pulmonary embolism. His complicated clinical course included intracranial haemorrhage and refractory ventricular arrhythmias. Eosinophilia and sub-endocardial hypoattenuation observed on chest computed tomography were key findings that led to the diagnosis of EGPA. Multiple anti-arrhythmic therapies were required as temporary measures whilst control of the underlying eosinophilic inflammation was achieved.Once stable, the patient was transferred to a tertiary cardiac centre for further investigation and cardioverter-defibrillator implantation. With EGPA now well controlled, he has experienced no further ventricular arrhythmias and has fully recovered.
Cardiac complications of EGPA, including ventricular arrhythmias, are difficult to manage without concurrent immunosuppression, which may itself further destabilize cardiac electrophysiology. The role of multiple imaging modalities in the diagnosis and monitoring of EGPA is emphasized, with cardiac magnetic resonance imaging playing a crucial role in detecting sub-endocardial fibrosis.
嗜酸性肉芽肿性多血管炎（EGPA）是一种罕见的血管炎，与严重的心脏发病率和死亡率相关。本病例报告介绍了在偏远综合医院环境中EGPA相关心律失常的诊断和管理挑战。
一名64岁的白种男性最初表现为疲劳、呼吸急促和厌食等隐匿前驱症状，最终以肺栓塞急性发作为结局。他复杂的临床病程包括颅内出血和难治性室性心律失常。胸部计算机断层扫描观察到的嗜酸性粒细胞增多和心内膜下低密度是导致EGPA诊断的关键发现。在控制潜在的嗜酸性炎症的同时，需要多种抗心律失常治疗作为临时措施。病情稳定后，患者被转至三级心脏中心进行进一步检查和植入心脏复律除颤器。目前EGPA得到良好控制，他未再出现室性心律失常并已完全康复。
EGPA的心脏并发症，包括室性心律失常，在没有同时进行免疫抑制的情况下很难管理，而免疫抑制本身可能会进一步破坏心脏电生理的稳定性。强调了多种成像方式在EGPA诊断和监测中的作用，心脏磁共振成像在检测心内膜下纤维化方面起着关键作用。
