Open AccessVentricular tachycardia as the first manifestation of cardiac sarcoidosis
Author(s) -
Felix Mehrhof,
Martin Stockburger,
Hartwig Schuette,
Wilhelm Haverkamp,
Rainer Dietz
Publication year - 2009
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr.08.2008.0810
Subject(s) - medicine , cardiology , ventricular tachycardia , ejection fraction , interventricular septum , sinus rhythm , cardiac sarcoidosis , coronary artery disease , sinus tachycardia , sudden cardiac death , sarcoidosis , radiology , heart failure , atrial fibrillation , ventricle
The case of a 32-year-old man with sustained ventricular tachycardia and hypotension is described. Following pharmacological treatment the patient switched to a sinus rhythm and was transferred to a university hospital for further diagnostic procedures and treatment. Cardiac catherisation ruled out underlying coronary artery disease, and cardiac MRI as well as echocardiography demonstrated a moderately reduced left ventricular ejection fraction, marked thickening of the interventricular septum and extensive intramural and epicardial infiltration of both ventricles. Endomyocardial biopsies were inconclusive; an implantable cardioverter defibrillator (ICD) was implanted in order to prevent a fatal arrhythmic event. Only repeated lymph node biopsies revealed typical findings of granulomatous disease, which together with the clinical course and the cardiac MRI findings strongly supported cardiac sarcoidosis. A few days after initiation of therapy with corticosteroids, the patient experienced the first of a number of ICD discharges, demanding aggressive anti-arrhythmic treatment regimen for the future.