Ghallab Muhammad, Cancarevic Ivan, Noff Nicole C, Miller Daniel, Foster Allison, Alagha Zakaria, Sliem Ashraf, Bakshi Sanjiv
Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City (NYC) Health and Hospitals, New York, USA.
Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Cureus. 2023 Jun 7;15(6):e40078. doi: 10.7759/cureus.40078. eCollection 2023 Jun.
Sarcoidosis is a multisystem disorder of unknown etiology commonly associated with hilar lymphadenopathy and granulomas. Cardiac involvement is less common; however, sarcoidosis is a known cause of restrictive cardiomyopathy. It typically presents as new-onset arrhythmias or heart failure, although cases of sudden cardiac death have been reported. We present a case of a 56-year-old male with a known history of pulmonary sarcoidosis, not on active treatment, who presented to the emergency department with a week of continuous hiccups every few seconds associated with non-exertional dyspnea. An initial computed tomography (CT) scan of the chest showed multiple stellate-like ground-glass opacities and the progression of bronchiectasis. Troponins were negative. On the initial electrocardiogram (EKG), he was found to be in atrial flutter and was admitted to the medical floor. Cardiology was consulted for suspected cardiac sarcoidosis, and they recommended transfer to the tertiary care center for further evaluation. Upon arrival, the patient underwent catheter ablation for atrial flutter and returned to sinus rhythm after the procedure. The initial nuclear scan with gallium was not suggestive of cardiac sarcoidosis. However, subsequent cardiac magnetic resonance imaging (MRI) showed cardiac involvement. Due to the high risk of arrhythmias, the patient was scheduled for implantable cardioverter defibrillator placement before discharge. The patient was given oral prednisone. The patient was discharged in stable condition, and interrogation of the device found it well functioning, and no significant arrhythmias were noted. Presentation of cardiac sarcoidosis can be variable, and any should be considered in any patient with a known history of sarcoidosis who presents with atypical symptoms above the diaphragm, such as hiccups or with new-onset arrhythmias.
结节病是一种病因不明的多系统疾病，通常与肺门淋巴结肿大和肉芽肿有关。心脏受累较少见；然而，结节病是限制性心肌病的已知病因。它通常表现为新发心律失常或心力衰竭，尽管也有心脏性猝死的病例报道。我们报告一例56岁男性，有肺结节病病史，未接受积极治疗，因每隔几秒持续打嗝一周并伴有非劳力性呼吸困难而就诊于急诊科。胸部计算机断层扫描（CT）初查显示多个星状磨玻璃影及支气管扩张进展。肌钙蛋白阴性。心电图（EKG）初查发现他处于心房扑动，遂收入内科病房。因怀疑心脏结节病咨询了心脏病学专家，他们建议转至三级护理中心进一步评估。到达后，患者接受了心房扑动导管消融术，术后恢复窦性心律。最初的镓核素扫描未提示心脏结节病。然而，随后的心脏磁共振成像（MRI）显示有心脏受累。由于心律失常风险高，患者在出院前被安排植入植入式心脏复律除颤器。给予患者口服泼尼松。患者病情稳定出院，设备程控显示功能良好，未发现明显心律失常。心脏结节病的表现可能多种多样，对于任何有结节病病史且出现膈肌以上非典型症状（如打嗝）或新发心律失常的患者，均应考虑该病。
