Cardiovascular Disease |

Cardiac Sarcoidosis Presenting as Sudden Cardiac Death FREE TO VIEW

Najam ud Din*, MBBS; Mohammad Arif, MBBS; Timothy Ford, MD
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SUNY Upstate Medical University, Syracuse, NY

Chest. 2012;142(4_MeetingAbstracts):98A. doi:10.1378/chest.1382133
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SESSION TYPE: Cardiovascular Student/Resident Case Report Posters I

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Cardiac involvement is seen in 5% of patients with sarcoidosis [1] and is found in 20-30 percent cases of sarcoidosis at autopsy [2]. In some cases the initial presentation of sarcoidosis may be cardiac arrest.

CASE PRESENTATION: Our patient was a 54 years old Caucasian woman who presented with sudden cardiac death. The patient was revived with ACLS protocol and was air-transported to our hospital from a community hospital to which she was initially admitted. The patient had a background of non-ischemic cardiomyopathy and aortic valve stenosis of unknown causation. Her cardiomyopathy had improved following aortic valve surgery several years ago. She also had paroxysmal atrial fibrillation with rapid ventricular rate. She had recently been diagnosed with sarcoidosis from mediastinal lymph node biopsy but was not on Prednisone at the time of presentation. During hospitalization, cardiac catheterization was negative for coronary artery disease. Echocardiograms during this hospitalization showed Ejection fraction of 25-30% during periods of rapid ventricular rate and normal ejection fraction during periods of normal ventricular rate. A mild to moderate global hypokinesis of the left ventricle was also noted. A cardiac MRI was performed which showed areas of delayed myocardial enhancement in subendocardial locations near the left ventricular apex, the apical portion of the anterior and inferior wall and the lateral wall in mid-myocardial location. These finding fit cardiac sarcoidosis

DISCUSSION: Cardiac sarcoidosis is associated with cardiac rhythm disturbances including heart block of varying degrees, ventricular tachycardia and other ectopic rhytms. Likewise, cardiac sarcoidosis may underlie cases with unexplained cardiomyopathy, pericardial effusions and congestive heart failure [3].

CONCLUSIONS: It is important to consider cardiac sarcoidosis in patients with a diagnosis of the disease at other body sites who present with sudden cardiac death and without evidence of coronary artery disease. Early diagnosis of cardiac sarcoidosis may expedite prophylactic pacemaker insertion for irregular cardiac rythms and early intiation of immunosuppression for sarcoidosis.

1) Fahy, GJ, Marwick, T, McGreery, CJ, et al Doppler echocardiographic detection of left ventricular diastolic dysfunction in patients with pulmonary sarcoidosis. Chest 1996;109,62-66

2) Smedema JP, Snoep G, van Kroonenburgh MP, Cardiac involvement in patients with pulmonary sarcoidosis assessed at two university medical centers in the Netherlands.Chest. 2005 Jul;128(1):30-5

3) Deng, JC, Baughman, RP, Lynch, JP Cardiac involvement in sarcoidosis. Semin Respir Crit Care Med 2002;23,513-526

DISCLOSURE: The following authors have nothing to disclose: Najam ud Din, Mohammad Arif, Timothy Ford

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SUNY Upstate Medical University, Syracuse, NY




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