[A case of cardiac sarcoidosis with various electrocardiographic change]

The patient was a 61 year old woman of Japanese who was in good health until May 1983, when she came to our hospital because of the visual disturbance. The chest X-ray film showed bilateral hilar lymphadenopathy and a transbronchial lung biopsy revealed sarcoid granuloma. She received systemic steroids (10 to 40 mg/2 days of prednisolone) for visual disturbance from August 1983 to May 1986. Then steroid therapy was suspended temporarily. In August 1987, she was readmitted because of syncopal episodes. She was noted to have irregular bradycardia and the electrocardiogram revealed atrioventricular block and paroxysmal polymorphous ventricular tachycardia. Initially cardioversion to sinus rhythm was accomplished with direct current electric shock and temporary pacemaker was inserted and subsequently a permanent transvenous demand pacemaker implanted. The patient then became asymptomatic. Coronary arteriography revealed no significant organic stenosis and left ventriculogram showed a left ventricular aneurysm of the inferior wall of the left ventricle. A transvenous percutaneous right ventricular endomyocardial biopsy revealed non-specific myocardial degeneration with slight interstitial fibrosis. Thallium-201 myocardial perfusion scans revealed the inferior left ventricular defects. We conclude the syncopal episodes and electrocardiographic abnormalities of this case were due to massive myocardial sarcoidosis which caused left ventricular aneurysm.