Isolated Cardiac Sarcoidosis with High-Grade Heart Block: Utilization of New Diagnostic Guidelines

Abstract

Cardiac sarcoidosis can present with heart failure and conduction disease. This is a case of a 58-year-old male who presented for dyspnea, edema, and varying degrees of heart block. Using new updated diagnostic guidelines and multimodal cardiac imaging, he was diagnosed with isolated cardiac sarcoidosis.

Isolated Cardiac Sarcoidosis Presenting as Torsades de Pointes in a Patient With Non-ischemic Cardiomyopathy: A Case Report

“…Although the atrioventricular block is the most common presenting arrhythmia in patients with CS [13], there have been several reports of ventricular arrhythmia as the initial presentation of CS, particularly in patients with EF<25% [7,[14][15][16][17]. To emphasize, more than half of CS cases with EF<25% have ventricular tachycardia within five years of CS diagnosis [6]. Our patient had an ICD implanted about a year ago, which can be life-saving as the risk of sudden cardiac death is estimated to be 9% and 34% in patients with normal EF and with EF<25% or prior history of ventricular arrhythmia, respectively [6].…”

“…Recently, CMR and PET with FDG have largely replaced endomyocardial biopsy [6]. The classical findings of PET/CT with FDG and CMR in CS are patchy uptake and late gadolinium enhancement that is mainly seen in the basal segments of the septum and lateral wall and usually in the mid-myocardium and sub-epicardium, respectively [2].…”

“…To emphasize, more than half of CS cases with EF<25% have ventricular tachycardia within five years of CS diagnosis [ 6 ]. Our patient had an ICD implanted about a year ago, which can be life-saving as the risk of sudden cardiac death is estimated to be 9% and 34% in patients with normal EF and with EF<25% or prior history of ventricular arrhythmia, respectively [ 6 ].…”

“…Endomyocardial biopsy was used to diagnose CS, but it is invasive, and its value is highly limited by its low sensitivity due to the patchy nature of sarcoidosis. Recently, CMR and PET with FDG have largely replaced endomyocardial biopsy [ 6 ]. The classical findings of PET/CT with FDG and CMR in CS are patchy uptake and late gadolinium enhancement that is mainly seen in the basal segments of the septum and lateral wall and usually in the mid-myocardium and sub-epicardium, respectively [ 2 ].…”

“…The clinical presentation of CS is highly variable, ranging from asymptomatic to life-threatening conduction disturbances, such as atrial or ventricular arrhythmias, and heart failure [ 4 ]. Historically, the diagnosis of CS required endomyocardial biopsy, but due to its low sensitivity rate of 20-30% and invasiveness, it has been largely replaced by cardiac magnetic resonance imaging (CMR) and positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) [ 6 ]. Corticosteroid is the mainstay of therapy for CS, and prompt recognition and treatment are essential to decrease CS morbidity and mortality.…”