Tuesday, January 6, 2015

Cardiac Sarcoidosis
-A case report -

"47-year-old male presented to the cardiology out-patient department (OPD) with shortness of breath and chest discomfort on exertion since one week. Chest discomfort was related to exertion and relieved by rest. He has hypertension and hypertriglyceridemia controlled well on oral Amlodipine and Fenofibrate since one year. He does not smoke, drink alcohol, or use any recreational drugs. The patient gives past history of cutaneous sarcoidosis which was diagnosed by biopsy of the lesion one year back. He was evaluated for systemic sarcoidosis and was found to have hilar lymph nodes by computed axial tomography of chest and was advised for a follow-up CT after 6 months. The follow-up CT scan showed improvement and the patient was asymptomatic.......Three months after this evaluation, he presented to our OPD with the present symptoms. ......At the time of presentation his electrocardiography (ECG) revealed sinus rhythm with a rate of 62 per minute with prolonged PR interval and right bundle branch block (RBBB). Cardiac enzymes were normal......His stress test showed poor chronotropic response and rate dependent 2 : 1 atrioventricular (AV) block occurring during the exercise test.......coronary angiography next day which showed normal coronaries.........."
EKG showing complete heart block.
Ventricular rate is 25 per minute,
QRS complex is very wide and
there is AV dissociation.
Read full case report, EKGs, CXR and discussion here

Reference: Nagham Saeed Jafar and col., Rapidly Progressive Atrioventricular Block in a Patient with Sarcoidosis - Case Reports in Cardiology- Volume 2014 (2014)

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