Abstract 16341: A Rare Case of Dual Cardiomyopathy: Acute Decompensated Heart Failure Secondary to Eosinophilic Myocarditis and Ischemic Cardiomyopathy

Abstract

Introduction: Dual cardiomyopathy, characterized by the coexistence of two distinct forms of myocardial dysfunction, is a rare phenomenon with complex diagnostic and therapeutic challenges. We present a unique case of a patient with combined eosinophilic myocarditis and ischemic cardiomyopathy. Case Presentation: A 65-year-old female with history of peripheral eosinophilia presented with worsening dyspnea and abdominal pain. CT abdomen was notable for right renal artery thrombosis. Troponin I was elevated at 0.057 ng/ml and 0.056 ng/ml. Notably, her absolute eosinophil count was elevated to 20.34 K/mcL. EKG with LVH and repolarization abnormalities. TTE showed a severely reduced LVEF of 18% and severe global hypokinesis. Decision Making: Given her newly diagnosed cardiomyopathy, a cardiac MRI was obtained that demonstrated presence of two moderate-sized cylindrical thrombi in the LV and subendocardial late gadolinium enhancement in the basal to mid antero/inferoseptum and inferolateral wall, characteristic of both myocardial infarction and eosinophilic myocarditis (Figure 1). She underwent a coronary angiogram that revealed severe mid LAD and OM1 artery stenosis that required PCI. She was initiated on appropriate medical therapy including steroids with normalization of her peripheral eosinophilia and improvement in her clinical symptoms. Discussion: This case highlights the intricate interplay between eosinophilic myocarditis and underlying ischemic cardiomyopathy. The timely initiation of appropriate therapies, including corticosteroids for eosinophilic myocarditis and revascularization for ischemic cardiomyopathy, can lead to favorable outcomes in these complex cases. Figure 1: Cardiac MRI showing inferolateral LGE and Cylindrical LV thrombi.