Editorial - Journal of Cholesterol and Heart Disease (2019) Volume 3, Issue 4
Heart Congress 2019: Role of cardiac MRI: Diagnosis of infective endocarditis - Reena Anand- Max Super Specialty Hospital
Patient came with history of Plasmodium vivax malaria with hypereosinophilia. He was treated for 21 days and with Hetrazan tablet with two doses and steroids. Provisional diagnosis was made of acute leukemia, eosinophilia and malaria and patient was referred for further management. Echocardiography was done which showed echogenic mass in left and right ventricular apical (L-RVA) region. Ejection fraction was 45%. Cardiac MRI was done for further evaluation which showed dilated right and left atria. There was evidence of a clot mass in L-RVA. The ventricular systolic function was normal. There was sub-endocardia enhancement in L-RVA region. The radiological diagnosis was infective endocarditis. After clinicopathological correlation eosinophilic endocarditis was considered. Loffler???s endocarditis and cardiac manifestations of the Hyper Eosinophilic Syndrome (HES) are rare and difficult to diagnose. The Transthoracic Echocardiogram (TTE) demonstrated normal systolic cardiac functions and a Left Ventricular Apical (LVA) thrombus. However, using Cardiovascular Magnetic Resonance (CMR), clearly demonstrate endocardial fibrosis, tissue inflammation, apical Ventricular Hypertrophy (VH) and LV thrombus that correlate with clinical findings. CMR plays an important role in the diagnosis and prognosis of this condition. Medical treatment included diuretics and anti-rheumatic medication, which were used to improve dyspnea. Initially, the patient received low molecular weight heparin (Clexane) treatment. It was withdrawn under cover of the warfarin anticoagulant (Marevan). The patient was advised to continue on Marevan treatment and discharged from the hospital.
Reena Anand is working as Head of Cardiac Imaging at Max Super Specialty Hospital, New Delhi, India. She has extensive experience on cardiac MRI from New York University. She has given various national and international talks providing training to emerging cardiac radiologist and cardiac technologists worldwide. She has numerous national and international publications to her credit. She is an active Member of Society of Cardiovascular Magnetic Resonance (SCMR).
Author(s): Reena Anand