Hashimura Miho, Ikeda Yuki, Koitabashi Toshimi, Ako Junya
Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan.
Eur Heart J Case Rep. 2023 Feb 1;7(2):ytad045. doi: 10.1093/ehjcr/ytad045. eCollection 2023 Feb.
Cardiac sarcoidosis (CS) occasionally disrupts circulatory haemodynamics due to arrhythmia or cardiac dysfunction.
A 70-year-old woman was diagnosed with CS, then was admitted for syncope because of complete atrioventricular block and frequently non-sustained ventricular tachycardia. Although a temporary pacemaker and intravenous amiodarone were introduced, she subsequently went into cardiopulmonary arrest by ventricular fibrillation. After the return of spontaneous circulation, Impella cardiac power (CP) was introduced because of sustained hypotension and severely impaired left ventricular contraction. High-dose intravenous corticosteroid therapy was simultaneously introduced. Her atrioventricular conduction and left ventricular contraction drastically improved. Impella CP was successfully removed after 4 days of support. She was eventually administered steroid maintenance therapy and discharged.
We report a case of CS with fulminant haemodynamic collapse treated with high-dose intravenous corticosteroid therapy under Impella assistance for acute haemodynamic support. Although CS has been known as an inflammatory disease with progressive cardiac dysfunction and rapid deterioration due to fatal arrhythmias, it can be improved with steroid therapy. It was suggested that strong haemodynamic support by Impella could be a bridge to manifest the effects after introducing steroid therapy to patients with CS.
心脏结节病（CS）偶尔会因心律失常或心脏功能障碍而扰乱循环血流动力学。
一名70岁女性被诊断为CS，随后因完全性房室传导阻滞和频繁非持续性室性心动过速而因晕厥入院。尽管植入了临时起搏器并静脉注射了胺碘酮，但她随后因心室颤动而发生心肺骤停。自主循环恢复后，由于持续低血压和左心室收缩严重受损，引入了Impella心脏动力（CP）。同时引入了大剂量静脉注射皮质类固醇治疗。她的房室传导和左心室收缩显著改善。在支持4天后成功移除了Impella CP。她最终接受了类固醇维持治疗并出院。
我们报告了一例CS伴暴发性血流动力学崩溃的病例，在Impella辅助下接受大剂量静脉注射皮质类固醇治疗以进行急性血流动力学支持。尽管CS被认为是一种炎症性疾病，会导致进行性心脏功能障碍并因致命性心律失常而迅速恶化，但类固醇治疗可以改善这种情况。有人认为，Impella提供的强大血流动力学支持可能是在对CS患者引入类固醇治疗后显现效果的桥梁。
