Missing the beat: arrhythmia as a presenting feature of eosinophilic granulomatosis with polyangiitis

Palpitations are a common presenting symptom in patients attending the emergency department; however, eosinophilic infiltration of the myocardium is rarely the cause. This case describes a 77-year-old woman who presents with sudden onset palpitations and is later diagnosed with eosinophilic granulomatosis with polyangiitis (previously known as Churg-Strauss syndrome). Cardiac involvement does occur in 50% of cases but heart failure, myocarditis, pericarditis, constrictive pericarditis and myocardial infarction are much more commonly recognised complications. Arrhythmia is less well described. In this report, we propose eosinophilic inflammation as the precipitant for an aberrant conduction pathway.