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A 58 year old man, previously diagnosed with sarcoidosis, presented with acute onset palpitations. ECGs showed a broad complex tachycardia with a downward axis and a heart rate of 160 beats per minute, requiring cardioversion. Subsequent coronary angiography showed normal coronary arteries. The left ventriculogram illustrated a discrete saccular aneurysm on the anterior wall of the left ventricle. Endocardial biopsy showed evidence of non-caseating granulomata consistent with sarcoidosis. Staining for acid-fast bacilli and fungi were negative. The patient received an implantable cardioverter-defibrillator, and steroids. At follow up he is doing very well and enjoying an almost normal life.
Clinically evident cardiac involvement in sarcoidosis is rare. Historically most cases are reported post-mortem. The majority of reports are of heart failure and arrhythmias. Diagnosis depends on a suggestive clinical picture combined with appropriate histology from some organ, and the exclusion of other causes of non-caseating granulomata. When we tried to investigate the best management of cardiac sarcoid and in particular ventricular aneurysms, we found that there was a paucity of evidence available. The accepted practice appears to be instigation of corticosteroids, plus any appropriate additional cardiac intervention in the form of pacemakers and medication. In conclusion, we illustrate an interesting but unusual presentation of cardiac sarcoid.
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