Cardiac sarcoidosis presenting as recurrent ventricular tachycardia: a case report
Mir Yasir
2
Imran Masood
1
Aiffa Aiman
0
Sheikh Afaq
1
Ashok Bakaya
1
0
Department of Pathology, GMC
,
Bakshinagar, Jammu, J&K, 180017
,
India
1
Department of Medicine, ASCOMS & Hospitals
,
Sidhra, Jammu, J&K, 180017
,
India
2
Department of Surgery, ASCOMS & Hospitals
,
Sidhra, Jammu, J&K, 180017
,
India
Introduction: 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. Case presentation: 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. Conclusion: 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.
-
Introduction
Sarcoidosis is a multi-systemic, granulomatous disease
with occasional cardiac involvement [1]. 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.
Case presentation
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
EFCigGuroef 1the patient showing ventricular ectopics (Trigeminy) during the episode of palpitation
ECG of the patient showing ventricular ectopics (Trigeminy) during the episode of palpitation.
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.
Investigations revealed Hb-9 g/dl, W.B.C count- 8000/L,
Platelet count- 2 lakh/L, E.S.R- 30 mm, Peripheral blood
film- mild hypochromic picture, Blood sugar- 60 mg/dl,
Urea-21 mg/dl, creatinine- 1 g/dl, Albumin- 3.5 g/dL,
SGOT- 137 U/L, SGPT- 101 U/L, Alkaline
Phosphatase111 U/L, Serum Calcium- 1.0 mmol/l, Serum
Sodium137 meq/l, Serum Potassium- 3.7 mEq/l. Serum
amylase72 U/L. Her X-Ray chest showed bilateral hilar
prominence. Angiotensin converting enzyme levels were 209.7
(Normal = 65 to 114.4). An electrocardiogram showed
ventricular ectopics (Trigeminy) during the episode of
palpitation (Figure 1). She was put on beta-blocker and a
holter cardiac study was done. Patient was managed in
cardiac care unit for continuous ECG monitoring. On
continuous cardiac monitoring it was found that she was
having recurrent sustained ventricular tachycardias
completely coinciding with her feeling of palpitation and
sweating (Figure 2). Each Ventricular tacvhycardia lasted
for 30 sec to 2 minutes. Her blood pressure remained
stable during the arrhythmias. After a loading dose of
continuous infusion of amiodarone, frequency of stable
Ventricular tacvhycardias decreased but persisted and a
she was then chemically cardioverted with continuous
infusion both amiodarone and lidocaine.
Echocardiography was done which showed only trivial Mitral
Regurgitation, with no evidence of Congestive heart failure with
preserved ejection fraction.
CECT chest showed significant anterior mediastinal and
bilateral hilar lymphadenopathy with FNAC of hilar
nodes showing features of non-caseating granuloma.
Endomyocardial biopsy was performed at the
interventricular septum. Cardiac biopsy showed non-caseating
granulomata, highly suggestive of a diagnosis of cardiac
sarcoidosis (Figure 3). A diagnosis of cardiac sarcoid was
made on the basis of these CECT findings, histology, and
the clinical picture.
EFCigGuroef 2the same patient revealing ventricular tachycardia preceded by normal sinus rhythm
ECG of the same patient revealing ventricular tachycardia preceded by normal sinus rhythm.
(FHBii (...truncated)