Saad Shaukat Muhammad Hamza, Fahad Fadi, Weinreb David, Torosoff Mikhail
Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA.
Cardiology, Albany Medical Center Hospital, Albany, New York, USA.
BMJ Case Rep. 2019 Mar 9;12(3):e227143. doi: 10.1136/bcr-2018-227143.
A previously healthy 44-year-old Caucasian man presented with recurrent syncope and was found to have a complete heart block with a ventricular rate of 24 bpm. No biochemical abnormalities were identified. Tick borne illnesses were ruled out. Paced echocardiogram revealed left ventricular systolic dysfunction with septal hypokinesis. Chest radiography and subsequent CT scan did not reveal adenopathy. However, a positron emission tomography scan demonstrated increased fluorodeoxyglucose uptake in the spleen, a right retro-clavicular lymph node, right ventricle and the interventricular septum of the heart. Excision biopsy of the retro-clavicular lymph node revealed non-caseating granulomas consistent with sarcoidosis. Complete heart block persisted despite steroid treatment. A pacemaker/biventricular implantable cardioverter defibrillator was placed for complete heart block and primary prevention of ventricular tachycardia and sudden cardiac death.
一名既往健康的44岁白种男性出现反复晕厥，经检查发现存在完全性心脏传导阻滞，心室率为24次/分钟。未发现生化异常。排除了蜱传疾病。经起搏超声心动图检查发现左心室收缩功能障碍，室间隔运动减弱。胸部X线检查及随后的CT扫描未发现淋巴结肿大。然而，正电子发射断层扫描显示脾脏、右侧锁骨后淋巴结、右心室及心脏室间隔的氟脱氧葡萄糖摄取增加。右侧锁骨后淋巴结切除活检显示非干酪样肉芽肿，符合结节病。尽管接受了类固醇治疗，完全性心脏传导阻滞仍持续存在。因完全性心脏传导阻滞以及为预防室性心动过速和心源性猝死进行一级预防，植入了起搏器/双心室植入式心脏复律除颤器。
