Eosinophilic Heart Disease: Pathophysiology, Diagnosis, and Management - A Narrative Review

Eosinophilic heart disease (EHD) is an inflammatory cardiac disorder characterized by the infiltration and subsequent heart tissue damage mediated by eosinophils. The clinical manifestations of EHD vary widely, ranging from asymptomatic to severe, life-threatening conditions. Diagnosis relies on a multimodal approach, incorporating clinical presentations, laboratory findings (e.g. hypereosinophilia), and advanced imaging studies such as cardiac magnetic resonance imaging (MRI) and echocardiography. However, the gold standard for definitive diagnosis remains endomyocardial biopsy, which demonstrates eosinophilic infiltration and associated myocardial injury. Currently, there is no established consensus on specific therapeutic protocols for EHD. Management primarily targets the underlying etiology and mitigates eosinophil-induced cardiac damage. Prognosis is highly variable and largely dependent on the causative pathology, with outcomes spanning from rapidly progressive and fatal courses to indolent, chronic disease progression. Given the heterogeneity in clinical presentation and treatment responses, there is an urgent need for evidence-based clinical guidelines to standardize the management of EHD.