Cardiac sarcoidosis presenting as recurrent ventricular tachycardia: a case report
© Yasir et al; licensee BioMed Central Ltd. 2009
Received: 30 November 2009
Accepted: 18 December 2009
Published: 18 December 2009
Sarcoidosis is a multi-systemic disorder involving various organ systems. Though cardiac involvement is uncommon it can present as life threatening arrhythmias and sudden death.
Here we present 27 years old married female with a series of arrhythmias with no initially obvious aetiology. On further evaluation she was diagnosed as having cardiac sarcoidosis.
Cardiac sarcoidosis is an important cause of death in patients with systemic sarcoidosis. It is therefore necessary to have high index of suspicion when symptoms are present rather than ignoring them.
Sarcoidosis is a multi-systemic, granulomatous disease with occasional cardiac involvement . Cardiac sarcoidosis may cause various symptoms including congestive cardiac failure, arrhythmias, conduction disturbance and sudden death depending on the extent and site of cardiac involvement [2, 3]. We describe a patient of cardiac sarcoidosis presenting with recurrent ventricular tachycardia.
27 years old married Indian female with Indoaryan ethinicity presented to the hospital with a history of sudden onset palpitation, sweating with cold hands and feet, since the last 3 months. These symptoms were intermittent and usually used to last for 1-5 minutes. There was no history of syncope, chest pain, breathlessness, hemoptysis, fever, history suggestive of rheumatic heart disease or any substance abuse. 1 year back patient had fever which lasted for 2 weeks along with enlarged preauricular lymph node.
FNAC of the node had revealed it to be a non-caseating granulomatous pathology. Patient was put on anti-tubercular therapy by family physician that she continued for 9 months. There is also history of anterior uveitis 6 months back and 4 months back she had infra-nuclear type of facial palsy. She had complete recovery from these symptoms. She was put on proton pump inhibitors since last 3 months by her treating physician attributing her complaints of palpitation and uneasiness to some epigastric discomfort.
On examination patient was conscious, oriented, had mild pallor but no icterus, cyanosis, edema or clubbing. She had a small non-tender lymph node palpable, in her left submandibular region. Her blood pressure was 100/70 mmHg with no postural drop, Pulse; 80/mt, regular. She was afebrile and had no features of respiratory distress.
Patient was simultaneously put on prednisolone 60 mg/day and shifted to oral amiodarone 200 mg tid. Due to poor financial status of the patient, implantation of intracardiac defibrillator was not possible in our case. Patient was discharged in a good clinical condition after 7 days of hospital stay.
Sarcoidosis should always be considered in differential diagnosis of ventricular tachycardia of unidentified cause. Cases of sudden death in patients of cardiac sarcoidosis have been reported. Arrhythmia control in cardiac sarcoidosis is difficult, and all modern treatment including high dose of steroids, anti-arrhythmic, implantable intracardiac defibrillators and catheter ablation are needed to suppress the arrhythmia . Prospective trial data do not exist, but spontaneous VT, severe LV dysfunction, and severe intraventricular conduction disturbance warrant ICD and/or pacemaker therapy as appropriate . Cardiac sarcoidosis is an important cause of death in patients with systemic sarcoidosis . It is therefore necessary to have high index of suspicion when symptoms are present rather than ignoring them. The prognosis of myocardial sarcoidosis is poor and depends on arrhythmias and conduction disorders [7, 8].
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of written consent is available for review by Editor-in-Chief of this journal.
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