Eosinophilic cardiomyopathy: Difference between revisions

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=== Prevention ===
=== Prevention ===
*There are no primary preventive measures available for [disease name].
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.
   
   
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.<ref>{{Cite journal
 
| author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
| title = Eosinophilic Myocarditis: Clinical Case and Literature Review
| journal = [[Arquivos brasileiros de cardiologia]]
| volume = 110
| issue = 6
| pages = 597–599
| year = 2018
| month = June
| doi = 10.5935/abc.20180089
| pmid = 30226920
}}</ref>


==References==
==References==

Revision as of 22:08, 5 May 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.[1] It is a feature of Hypereosinophilic Syndrome and occurs in 40-50% of all cases.[2] [3] Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines.[4] This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the Eosinophilic cardiomyopathy:[5]

  • Stage 1: Acute necrotic stage
  • Stage 2: Mural thrombi/ thrombus formation
  • Stage 3: Fibrotic stage

There are many causes of Hyperesosinophilic Syndrome (HES) with Eosinophilic Cardiomyopathy, these can be classified as:

  • Reactive[6][7]
    • Eosinophillic Granulomatosis Polyangitis[8][9][10]
    • Parasitic Infection
    • Autoimmune disorder
    • Medication related [11]
  • Clonal Myeloid Disorder[12][13]
  • Idiopathic Hypereosinophillic Syndrome [14][15]

Historical Perspective

  • Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].[16] [17]

Classification

  • Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:

Pathophysiology

  • The pathogenesis of Eosinophilic Cadiomyopathy is characterized by hypereosinophilia [24], thrombi formation [25], restrictive cardiomyopathy[26] [27], and heart failure [28].
  • The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia [29]and hypereosiniophilic syndrome.[30] [31]
  • The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.[32] [33]
  • On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.[34]
  • On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.[35]

Clinical Features

Differentiating [disease name] from other Diseases

  • Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause Cardiac hypertrophy, cardiac fibrosis, and Heart failure[41], such as:

Epidemiology and Demographics

  • The prevalence of Hypereosinophilic Syndrome is approximately 0.036 per 100,000 individuals worldwide. [45]

Age

  • Patients of all age groups may develop Eosinophilic Cardiomyopathy.[46]
  • Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.[47]

Gender

  • Men are more commonly affected with eosinophilic cadiomyopathy than Females.[48]
  • The Male to Female ratio is approximately 1.47. [49]

Race

  • There is no racial predilection for Eosinophilic Cardiomyopathy.

Risk Factors

  • Common risk factors in the development of Eosinophilic Cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels,

dysplastic eosinophils, and abnormal early myeloid precursors.[50]

Natural History, Complications and Prognosis

  • Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.[51]
  • Early clinical features include dyspnea, fever, and chest pain.[52]
  • If left untreated, patients with Eosinophilic Cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.[53]
  • Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

  • The diagnosis of Hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:[54] [55]
  • an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
  • tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
  • marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

Symptoms

  • Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.[56]
  • Symptoms of Eosinophilc Cardiomypoathy may include the following:[57] [58]
  • Fever
  • Dyspnea at rest or on exertion
  • Chest pain
  • Cough
  • Rash
  • Malaise

Physical Examination

  • Patients with Eosinophilic Cardiomyopathy usually appear distressed.
  • Physical examination may be remarkable for:[59] [60]
  • Fever
  • Tachycardia
  • Tachypnea
  • Arrythmia
  • Rash
  • Embolic events

Laboratory Findings

  • A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.[61]
  • An elevated concentration of eosinophils in peripheral blood smear is diagnostic of Hypereosinophilic syndrome.[62]
  • Other laboratory findings consistent with the diagnosis of Eosinophilic cardiomyopathy include abnormal bone marrow biopsy, and abnormal troponins.[63]

Imaging Findings

  • Cardiac MRI is the imaging modality of choice for Eosinophilic cardiomyopathy.[64]
  • On Cardiac MRI, Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. [65]
  • Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvment.[66]

Other Diagnostic Studies

  • Eosinophilic Cardiomyopathy may also be diagnosed using ECG.[67]
  • Findings on ECG include T wave inversion, Left atrial enlargement, Left ventricular hypertrophy, and Right bundle branch block.[68]

Treatment

Medical Therapy

  • The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
  • The mainstay of therapy is supportive care.


  • The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.[69]
  • Symptomatic management includes diuretics, Beta Blockers, ACE inhibitors, Angiotensin Receptor Blockers, and Digoxin.[70] [71]
  • Imatinib acts by inhibition of tyrosine kinase.[72]
  • Response to treatment can be monitored with cardiac biopsy.[73]

Surgery

  • Surgery is the mainstay of therapy for [disease name].
  • [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
  • Valve replacement may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.[74]
  • Cardiac Transplant may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.[75]

Prevention

  • There are no primary preventive measures available for Eosinophilic Cardiomyopathy.
  • Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.[76]

References

  1. Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  2. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  3. Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  4. M. Arima & T. Kanoh (1999). "Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP". Heart (British Cardiac Society). 81 (6): 669–671. PMID 10336931. Unknown parameter |month= ignored (help)
  5. Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  6. Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  7. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  8. Gustav Mattsson & Peter Magnusson (2017). "Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids". BMC cardiovascular disorders. 17 (1): 299. doi:10.1186/s12872-017-0734-8. PMID 29262787. Unknown parameter |month= ignored (help)
  9. Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  10. Raquel Miriam Ferreira, Pedro Madureira, Teresa Pinho, Elisabete Martins, Sofia Pimenta & Lucia Costa (2018). "Silent acute myocarditis in eosinophilic granulomatosis with polyangiitis". Acta reumatologica portuguesa. 43 (4): 309–313. PMID 30641540. Unknown parameter |month= ignored (help)
  11. Nooreen Hussain, Preeti Patel, Jonathan Yin, Rachael Davis & Ossama Ikladios (2019). "A case of Loeffler's endocarditis after initiation of adalimumab". Journal of community hospital internal medicine perspectives. 9 (1): 29–32. doi:10.1080/20009666.2018.1562852. PMID 30788072.
  12. Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  13. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  14. Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  15. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  16. Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  17. Amit Alam, Shankar Thampi, Shahryar G. Saba & Rita Jermyn (2017). "Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis". Clinical medicine insights. Case reports. 10: 1179547617723643. doi:10.1177/1179547617723643. PMID 28890659.
  18. Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  19. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  20. Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  21. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  22. Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  23. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  24. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  25. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  26. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  27. Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  28. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  29. Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  30. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  31. Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  32. Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  33. Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  34. Gustav Mattsson & Peter Magnusson (2017). "Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids". BMC cardiovascular disorders. 17 (1): 299. doi:10.1186/s12872-017-0734-8. PMID 29262787. Unknown parameter |month= ignored (help)
  35. A. Angelini, V. Calzolari, G. Thiene, G. M. Boffa, M. Valente, L. Daliento, C. Basso, F. Calabrese, R. Razzolini, U. Livi & R. Chioin (1997). "Morphologic spectrum of primary restrictive cardiomyopathy". The American journal of cardiology. 80 (8): 1046–1050. PMID 9352976. Unknown parameter |month= ignored (help)
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  37. Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  38. Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  39. Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  40. Nooreen Hussain, Preeti Patel, Jonathan Yin, Rachael Davis & Ossama Ikladios (2019). "A case of Loeffler's endocarditis after initiation of adalimumab". Journal of community hospital internal medicine perspectives. 9 (1): 29–32. doi:10.1080/20009666.2018.1562852. PMID 30788072.
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  45. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  46. Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  47. Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  48. Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  49. Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  50. Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  51. Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  52. Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  53. Paulo Dinis, Rogerio Teixeira, Luis Puga, Carolina Lourenco, Maria Carmo Cachulo & Lino Goncalves (2018). "Eosinophilic Myocarditis: Clinical Case and Literature Review". Arquivos brasileiros de cardiologia. 110 (6): 597–599. doi:10.5935/abc.20180089. PMID 30226920. Unknown parameter |month= ignored (help)
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