Electrocardiographic abnormalities in patients with pulmonary sarcoidosis (RCD code: III)

Abstract

Sarcoidosis is a systemic inflammatory disease characterized by the presence of noncaseating granulomas. Etiology of the disease remains unknown. From 3.7% to 54.9% patients with extra-cardiac sarcoidosis have asymptomatic heart involvement. Conduction abnormalities, arrhythmias and congestive heart failure are the most common clinical manifestations of cardiac sarcoidosis (CS). The aim of the study was to evaluate the type and frequency of electrocardiographic abnormalities in patients with pulmonary sarcoidosis and to compare differences in the occurrence of electrocardiographic changes between patients diagnosed with CS and patients without confirmation of CS. Materials and methods: 49 patients (18 women, 31 men), mean age 45.6 ±12.2 years with biopsy-proven pulmonary sarcoidosis were enrolled in the study. The patients were divided into two groups. Group 1 consisted of 12 patients diagnosed with CS, and Group 2 of 37 patients without diagnosis of CS. 12-lead baseline electrocardiogram (ECG) was recorded for all participants. Results: 89.8% patients with pulmonary sarcoidosis had abnormal ECG. The most common ECG abnormalities were ST-T changes observed in 79.6%. Conduction abnormalities were present in 26.5% of patients. 22.45% patients had left axis deviation. Rhythm abnormalities were recorded in 20.4% of all analyzed ECGs. ECGs of 8.16% of patients met criteria of hypertrophy. There was a trend towards more frequent prevalence of some ECG changes in patients with CS than patients without CS. However, these differences were not statistically significant. Conclusions: We observed a trend towards more frequent prevalence of some ECG abnormalities in a group of patients with CS than in patients without CS. However, these differences were not statistically significant. ECG abnormalities in patients with pulmonary sarcoidosis require further diagnostics. JRCD 2017; 3 (3): 81-85

The Controversies, Challenges and Complexities of Lyme Disease: A Narrative Review

“…Lyme Borreliosis is an immune mediated disease secondary to exposure to Borrelia burgdorferi. 4,5 It is a complex disease where both the specific disease causing organism and the host responses appear to affect the disease course. 14 Different strains of Borrelia are exist with clinical manifestations of Lyme disease (and co-infections) varying between the US and Europe, and characterised by a diverse range of acute and chronic manifestations.…”

“…32 The infecting pathogen can spread to organs and other tissues, and can severely affect the patients nervous system, joints, heart and skin. 4,5,11,26,32 Arthritis is the most common late state symptom in the US, but in Europe, radiculomyelitis, peripheral neuropathy, or chronic skin involvement (acrodermatitis chronica atrophicans) is more common. 14 Lyme carditis is a real diagnostic and therapeutic challenge for clinicians.…”

“…14 Lyme carditis is a real diagnostic and therapeutic challenge for clinicians. 5 It is not uncommon for patients to initially present with late stage disease. 3 This complicates clinical diagnosis, with additional complicating factors making diagnosis problematic including the negation of tick bite, absence of EM, atypical clinical picture, onset of symptoms outside of the period of tick activity, and negative serological results in the initial stages of the disease.…”

“…3 This complicates clinical diagnosis, with additional complicating factors making diagnosis problematic including the negation of tick bite, absence of EM, atypical clinical picture, onset of symptoms outside of the period of tick activity, and negative serological results in the initial stages of the disease. 5,10,33 More recently, the debate centres around the ICD system for Lyme Borrelisis, where the diverse range of manifestations, stages and complications of this disease are not stated, and are restricted to the acute form of Lyme. 2 The Problematic Interpretation of Serologic Testing Complications exist around the role of serologic testing in the clinical diagnosis and management of the patient.…”

“…4 Geographic distribution and incidence of Lyme disease is on the increase worldwide, and has become the most common vector-borne illness in Europe particularly Austria, Czech Republic, Germany, Slovenia, and Switzerland; and in China, Australia, Africa and North East United States (US). 2,5,6,7,8,9,10,11 Lyme disease or Lyme Borreliosis is caused by spirochaetes of the B burgdorferi sensu lato o species complex and is transmitted by infected Ixodes scapularis or Ixodes ricinus ticks. 5,6,7,10,11 In 2000, Rowe reported that Lyme disease in Europe is caused by any one of three tick borne spirochetes in the B. burgdorferi sensu lato complex-B burgdorferi sensu stricto, B afzelii, and B garinii, whereas in the US, only the first species is involved.…”