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Systemic sarcoidosis presenting as complete heart block in a patient with normal chest radiography

Muhammad Hamza Saad Shaukat1, Fadi Fahad2, David Weinreb3

  • 1Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA.

BMJ Case Reports
|March 11, 2019
PubMed

Insights

A man with complete heart block was diagnosed with cardiac sarcoidosis. Despite steroid treatment, a pacemaker was implanted for heart function and sudden cardiac death prevention.

Area of Science:

  • Cardiology
  • Immunology
  • Pathology

Background:

  • Cardiac sarcoidosis is a rare inflammatory condition affecting the heart.
  • It can lead to severe conduction abnormalities and heart failure.
  • Early diagnosis and management are crucial for patient outcomes.

Observation:

  • A 44-year-old man presented with syncope due to complete heart block (24 bpm).
  • Initial investigations, including biochemical tests and echocardiography, showed left ventricular dysfunction.
  • Positron emission tomography revealed abnormal fluorodeoxyglucose uptake in the spleen, lymph nodes, and heart, prompting further investigation.

Findings:

  • Biopsy of a retro-clavicular lymph node confirmed non-caseating granulomas, indicative of sarcoidosis.
  • The patient's complete heart block persisted despite steroid therapy.
  • Cardiac involvement was evident with granulomatous infiltration of the interventricular septum.

Implications:

  • This case highlights the importance of considering sarcoidosis in unexplained heart block and cardiac dysfunction.
  • It underscores the challenges in managing cardiac sarcoidosis, as standard treatments may not always be effective.
  • The implantation of a biventricular implantable cardioverter defibrillator was necessary for managing the complete heart block and preventing sudden cardiac death.

Keywords:
arrhythmiasradiology (diagnostics)

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