Loeffler Endocarditis Clinical Presentation

Updated: Feb 06, 2020
  • Author: Sohail A Hassan, MD; Chief Editor: Richard A Lange, MD, MBA  more...
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Presentation

History

Patients with Loeffler endocarditis may present with weight loss, fever, cough, rash, and symptoms related to congestive heart failure. Initial cardiac involvement has been reported in about 20-50% of cases; however, cardiac involvement rarely presents with chest pain, as reported by Bestetti et al. [22]

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Physical Examination

Signs of biventricular failure (eg, pedal edema, elevated jugulovenous pressure, pulmonary edema, third heart sound [S3] gallop) are commonly seen once congestive heart failure develops. Other signs include the following:

  • Cardiomegaly may be present without overt signs of congestive heart failure.

  • Murmur of mitral regurgitation may be present, as reported by multiple authors, including Weller et al. [25]

  • Systemic embolism is frequent and may lead to neurologic and renal dysfunction.

  • The Kussmaul sign may be present.

  • S3 gallop may be present, but rarely fourth heart sound (S4).

  • Restrictive cardiomyopathy, such as Loeffler endocarditis, is sometimes difficult to differentiate from constrictive pericarditis. Physical signs in constrictive pericarditis that may help differentiate the two conditions include a nonpalpable apex (usually), presence of pericardial knock, and usually absent regurgitation murmurs.

  • Published case reports highlight presentations with unusual ECG changes mimicking posterior myocardial infarction as described by Maruyoshi et al, [26] acute myocardial infarction as described by Mor et al, [27] and aortic valve regurgitation secondary to valve fibrosis and fibrotic vegetations on the aortic valve as described by Gudmundsson et al. [28]

  • Recently, a presentation with inflow and outflow tract obstruction of the left ventricle with a large organized thrombus on the mitral valve apparatus was described. [29]

  • Occlusion and obstruction of the aortic bifurcation has been reported (Leriche syndrome). [30]

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