Department of Cardiology, Sussex Cardiac Centre, Brighton BN2 5BE, UK.
Europace. 2010 Feb;12(2):284-8. doi: 10.1093/europace/eup381. Epub 2009 Nov 27.
We present the case of a 55-year-old male who presented with symptoms of dyspnoea and pre-syncope. A 12 lead electrocardiogram demonstrated extensive conduction abnormalities with 2:1 heart block, right bundle branch block and a small Q wave in lead V(1.) This indicated significant myocardial and septal involvement. Echocardiography confirmed the presence of right ventricular infiltration and dysfunction whilst cardiac magnetic resonance showed the infiltration to be nodular in nature. Although a diagnosis of cardiac sarcoidosis and lymphoma were initially considered, sarcoidosis was eventually confirmed following a cervical lymph node biopsy. This case firstly demonstrates the usefulness of the 12-lead electrocardiogram in determining the likely anatomical locality of significant bradyarrhythmias. Secondly it highlights the difficulties in diagnosing cardiac sarcoidosis when cardiac dysfunction is the sole manifestation of the disease.
我们呈现了一例 55 岁男性病例，其出现呼吸困难和晕厥前兆的症状。12 导联心电图显示广泛的传导异常，存在 2:1 心脏阻滞、右束支阻滞和 V1 导联小 Q 波。这表明心肌和间隔有明显受累。超声心动图证实右心室浸润和功能障碍，而心脏磁共振显示浸润呈结节状。虽然最初考虑心脏结节病和淋巴瘤的诊断，但通过颈部淋巴结活检最终确诊为结节病。该病例首先证明了 12 导联心电图在确定显著缓心律失常的可能解剖部位方面的有用性。其次，它强调了当心脏功能障碍是疾病唯一表现时，诊断心脏结节病的困难。
