Saliba Fares, Mina Jonathan, Aoun Laurence, Khattar Georges, Bou Sanayeh Elie, Mourad Omar, Abu Baker Saif
Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, USA.
Eur J Case Rep Intern Med. 2024 May 2;11(6):004469. doi: 10.12890/2024_004469. eCollection 2024.
Cardiac sarcoidosis can cause a wide range of symptoms, including shortness of breath, chest pain, oedema, and fatal arrhythmias such as ventricular tachycardia (VT). Because the symptoms can be nonspecific, diagnosing cardiac sarcoidosis can be challenging. Treatment options may include corticosteroids to reduce inflammation, immunosuppressive drugs to prevent further damage, medications to control symptoms, ablation procedures, and defibrillators to prevent cardiac arrest.
A 60-year-old woman who has sarcoidosis affecting multiple organs including cardiac sarcoidosis, non-ischemic cardiomyopathy with reduced ejection fraction, and hypertension, was admitted with tachycardia, shortness of breath, and a recently fired automatic implantable cardioverter defibrillator (AICD). Three months prior, the patient was admitted for a syncopal episode and diagnosed with cardiac sarcoidosis through cardiac magnetic resonance imaging (MRI) and positron emission tomography (PET), which demonstrated active inflammation, and an AICD was implanted. During this admission, the patient had an episode of ventricular tachycardia and was treated with amiodarone and lidocaine. The patient received steroids, sacubitril/valsartan, and methotrexate. After 48 hours of observation, the patient was discharged without further events.
Cardiac sarcoidosis is a rare but serious disease that can lead to life-threatening cardiac complications such as ventricular tachycardia. Early diagnosis and aggressive management are crucial for improving outcomes and preventing sudden cardiac death. AICD implantation as a secondary prevention in cardiac sarcoidosis might prevent cardiac arrest."
Cardiac sarcoidosis can present with non-specific symptoms and lead to life-threatening arrhythmias such as ventricular tachycardia, emphasising the importance of early diagnosis and aggressive management to prevent sudden cardiac death.A multidisciplinary approach involving imaging modalities such as cardiac magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, along with histological findings, is crucial for accurately diagnosing cardiac sarcoidosis, as endomyocardial biopsy alone has low sensitivity.Implantation of an automatic implantable cardioverter defibrillator (AICD) as a secondary prevention measure should be considered in cardiac sarcoidosis patients, even in elderly individuals with mildly to moderately reduced ejection fraction, to prevent fatal arrhythmias and sudden cardiac death.
心脏结节病可引发多种症状，包括呼吸急促、胸痛、水肿以及诸如室性心动过速（VT）等致命性心律失常。由于症状可能不具特异性，诊断心脏结节病颇具挑战性。治疗方案可能包括使用皮质类固醇减轻炎症、使用免疫抑制药物防止进一步损伤、使用药物控制症状、进行消融手术以及植入除颤器以预防心脏骤停。
一名60岁女性，患有累及包括心脏结节病在内的多个器官的结节病、射血分数降低的非缺血性心肌病以及高血压，因心动过速、呼吸急促和近期已放电的自动植入式心律转复除颤器（AICD）入院。三个月前，患者因晕厥发作入院，通过心脏磁共振成像（MRI）和正电子发射断层扫描（PET）诊断为心脏结节病，检查显示存在活动性炎症，并植入了AICD。此次入院期间，患者发生室性心动过速发作，接受了胺碘酮和利多卡因治疗。患者接受了类固醇、沙库巴曲缬沙坦和甲氨蝶呤治疗。经过48小时观察后，患者未再出现其他情况而出院。
心脏结节病是一种罕见但严重的疾病，可导致危及生命的心脏并发症，如室性心动过速。早期诊断和积极治疗对于改善预后及预防心源性猝死至关重要。植入AICD作为心脏结节病的二级预防措施可能预防心脏骤停。
心脏结节病可表现为非特异性症状，并导致危及生命的心律失常，如室性心动过速，这凸显了早期诊断和积极治疗以预防心源性猝死的重要性。采用多学科方法，包括心脏磁共振成像（MRI）和正电子发射断层扫描（PET）扫描等影像学检查手段以及组织学检查结果，对于准确诊断心脏结节病至关重要，因为仅心内膜活检敏感性较低。对于心脏结节病患者，即使是射血分数轻度至中度降低的老年患者，也应考虑植入自动植入式心律转复除颤器（AICD）作为二级预防措施，以预防致命性心律失常和心源性猝死。
