RESTRICTIVE CARDIOMYOPATHY ASSOCIATED WITH THE EOSINOPHILIA-MYALGIA-SYNDROME

Objective: We report the first case of restrictive cardiomyopathy occu rring in a patient with the eosinophilia-myalgia syndrome. Design: In this article, we discuss the various clinical manifestations of the eo sinophilia-myalgia syndrome. Material and Methods: In a 46-year-old wo man with the eosinophilia-myalgia syndrome, orthopnea, chronic persist ent edema, and severe dyspnea on exertion developed 2 years after she had discontinued use of L-tryptophan. Doppler echocardiography showed ventricular filling confined to early diastole and no atrial filling d uring ventricular systole-the Doppler hallmarks of restrictive disease . Right-sided cardiac catheterization revealed that the pulmonary wedg e pressure equaled the pulmonary artery diastolic pressure and the mea n right atrial pressure. A myocardial biopsy specimen showed dense end ocardial fibrosis. Special immunofluorescent stains for eosinophilic g ranule major basic protein showed substantial deposition along the end ocardial-myocardial interface, an indication that eosinophils were pre sent some time in the past. Results: A follow-up telephone call 14 mon ths after the patient's initial assessment at the Mayo Clinic revealed that she had class III symptoms of congestive heart failure. She was receiving high doses of three diuretics daily, and her condition had i mproved considerably since her first examination at our institution. C onclusion: Restrictive cardiomyopathy may occur in the setting of the eosinophilia-myalgia syndrome and should be considered in patients wit h this disease in whom exertional dyspnea and peripheral edema occur.