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New Onset Cardiomyopathy and Recurrent Ventricular Tachycardia Secondary to Cardiac Sarcoidosis
Cardiovascular Disease SESSION TITLE: Student/Resident Case Report Poster - Cardiovascular Disease II SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM
New Onset Cardiomyopathy and Recurrent Ventricular Tachycardia Secondary to Cardiac Sarcoidosis Hoyle Whiteside BS* Farres Obeidin BS Gyanendra Sharma MD; and Jayanth Keshavamurthy MD Medical College of Georgia, Augusta, GA INTRODUCTION: The pathological hallmark of sarcoidosis is non-caseating granulomas most frequently affecting the lungs, however extra-pulmonary involvement is common. In patients with extracardiac sarcoidosis (ECS), symptomatic cardiac involvement will develop in approximately 5% of patients.1
DISCUSSION: Symptomatic cardiac sarcoidosis is a condition which develops in approximately 5% of patients with ECS and is associated with a worse prognosis. The most common sequelae of cardiac sarcoidosis are heart failure, conduction abnormalities, and ventricular arrhythmias.1 Cardiac involvement can occur at any time and sudden cardiac death may be the presenting feature. Cardiac MRI can be an effective screening tool in patients with a high suspicion of cardiac sarcoidosis.2 Cardiac MRI has a high negative predictive value and the presence of LGE is associated with an 11-fold increased hazard for cardiac death.2 CONCLUSIONS: Cardiac sarcoidosis is a diagnosis that should be considered in patients with unexplained non-ischemic cardiomyopathy and ventricular arrhythmias, especially in presence of hilar adenopathy. Accurate diagnosis can have significant therapeutic implications as patients have an increased risk of sudden cardiac death and have been shown to respond to oral steroid therapy. Reference #1: Birnie DH, Sauer WH, et al. HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. Heart Rhythm. 2014;11(7):1304-23 Reference #2: Hulten E, Aslam S, et al. cardiac sarcoidosis - state of the art review. Cardiovasc Diagn Ther. 2016 Feb;6(1):50-63. DISCLOSURE: The following authors have nothing to disclose: Hoyle Whiteside, Farres Obeidin, Gyanendra Sharma, Jayanth Keshavamurthy No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.105
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
97A
CARDIOVASCULAR DISEASE
CASE PRESENTATION: A 59 year old African American male with a recent diagnosis of non-ischemic cardiomyopathy (NICM) with left ventricular ejection fraction of 12% and moderate mitral regurgitation presented to the emergency department following three shocks from his LifeVest. He had a recent hospitalization for decompensated heart failure during which he had sustained ventricular tachycardia (VT) requiring cardioversion. Left heart catheterization revealed non-obstructive coronary arteries. He was discharged with a LifeVest. On presentation, vital signs were: BP 97/74, HR 104, RR 17, O2 sat 100%. Physical exam was significant for jugular venous distension, II/VI holosystolic murmur loudest at the apex, S3, bibasilar crackles, and lower extremity edema. Chest X-ray on admission was significant for stable cardiomegaly and extensive calcified hilar and mediastinal lymph nodes (Figure 1). Limited echocardiogram was unchanged from comparison study one month prior. CT thorax revealed innumerable calcified lymph nodes throughout the mediastinum and bilateral hilar regions consistent with granulomatous disease. Cardiac MRI revealed intramyocardial late gadolinium enhancement (LGE) involving the basal segments and the interventricular septum with sparing of the endocardial border, suggestive of cardiac sarcoidosis (Figure 2A and 2B). The patient underwent biventricular ICD placement the following day.
New Onset Cardiomyopathy and Recurrent Ventricular Tachycardia Secondary to Cardiac Sarcoidosis Hoyle Whiteside BS* Farres Obeidin BS Gyanendra Sharma MD; and Jayanth Keshavamurthy MD Medical College of Georgia, Augusta, GA INTRODUCTION: The pathological hallmark of sarcoidosis is non-caseating granulomas most frequently affecting the lungs, however extra-pulmonary involvement is common. In patients with extracardiac sarcoidosis (ECS), symptomatic cardiac involvement will develop in approximately 5% of patients.1
DISCUSSION: Symptomatic cardiac sarcoidosis is a condition which develops in approximately 5% of patients with ECS and is associated with a worse prognosis. The most common sequelae of cardiac sarcoidosis are heart failure, conduction abnormalities, and ventricular arrhythmias.1 Cardiac involvement can occur at any time and sudden cardiac death may be the presenting feature. Cardiac MRI can be an effective screening tool in patients with a high suspicion of cardiac sarcoidosis.2 Cardiac MRI has a high negative predictive value and the presence of LGE is associated with an 11-fold increased hazard for cardiac death.2 CONCLUSIONS: Cardiac sarcoidosis is a diagnosis that should be considered in patients with unexplained non-ischemic cardiomyopathy and ventricular arrhythmias, especially in presence of hilar adenopathy. Accurate diagnosis can have significant therapeutic implications as patients have an increased risk of sudden cardiac death and have been shown to respond to oral steroid therapy. Reference #1: Birnie DH, Sauer WH, et al. HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. Heart Rhythm. 2014;11(7):1304-23 Reference #2: Hulten E, Aslam S, et al. cardiac sarcoidosis - state of the art review. Cardiovasc Diagn Ther. 2016 Feb;6(1):50-63. DISCLOSURE: The following authors have nothing to disclose: Hoyle Whiteside, Farres Obeidin, Gyanendra Sharma, Jayanth Keshavamurthy No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.105
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
97A
CARDIOVASCULAR DISEASE
CASE PRESENTATION: A 59 year old African American male with a recent diagnosis of non-ischemic cardiomyopathy (NICM) with left ventricular ejection fraction of 12% and moderate mitral regurgitation presented to the emergency department following three shocks from his LifeVest. He had a recent hospitalization for decompensated heart failure during which he had sustained ventricular tachycardia (VT) requiring cardioversion. Left heart catheterization revealed non-obstructive coronary arteries. He was discharged with a LifeVest. On presentation, vital signs were: BP 97/74, HR 104, RR 17, O2 sat 100%. Physical exam was significant for jugular venous distension, II/VI holosystolic murmur loudest at the apex, S3, bibasilar crackles, and lower extremity edema. Chest X-ray on admission was significant for stable cardiomegaly and extensive calcified hilar and mediastinal lymph nodes (Figure 1). Limited echocardiogram was unchanged from comparison study one month prior. CT thorax revealed innumerable calcified lymph nodes throughout the mediastinum and bilateral hilar regions consistent with granulomatous disease. Cardiac MRI revealed intramyocardial late gadolinium enhancement (LGE) involving the basal segments and the interventricular septum with sparing of the endocardial border, suggestive of cardiac sarcoidosis (Figure 2A and 2B). The patient underwent biventricular ICD placement the following day.