Article Text

Rare disease
Ventricular tachycardia as the first manifestation of cardiac sarcoidosis
  1. Felix Mehrhof1,2,
  2. Martin Stockburger1,
  3. Hartwig Schuette3,
  4. Wilhelm Haverkamp1,
  5. Rainer Dietz1,2
  1. 1
    Charité University Medicine Berlin, Cardiology, Augustenburger Platz 1, Berlin, 13353, Germany
  2. 2
    German Competence Network of Heart Failure, Augustenburger Platz 1, Berlin, 13353, Germany
  3. 3
    Charité University Medicine Berlin, Infectious Diseases and Respiratory Medicine, Augustenburger Platz 1, Berlin, 13353, Germany
  1. Felix Mehrhof, felix.mehrhof{at}charite.de

Summary

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.

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Footnotes

  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication.

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