[Sudden cardiac death in a case of systemic sarcoidosis]

Abstract

Clinical presentation: A 55-year-old woman required emergency medical care because of sudden weakness. On arrival of the emergency physician the patient presented with bradycardia with a normal rhythm. The blood pressure was not measurable. The patient complained of recurrent dizziness for a few months. Subsequently, the patient presented with an asystole and required reanimation and insertion of a temporary cardiac pacemaker. On admission at the hospital myocardial infarction was suspected.

Clinical and laboratory tests: At the time of admission the patient presented in cardiogenic shock. The ECG revealed a 3rd atrioventricular block with idioventricular rhythm. Echocardiography showed reduced left ventricular function with global hypokinesia of the myocardium. Coronary artery disease was excluded by angiography. To exclude acute pulmonary embolism a CT-scan of the thorax was performed, revealing enlarged lymph nodes in the mediastinum.

Treatment and response to therapy: Despite the administration of high-dose catecholamines and before a left atrial-to-femoral arterial assist device could be completely implanted the patient died of cardiogenic shock.

Autopsy: Autopsy revealed non-caseating epitheloid granulomas in the enlarged mediastinal lymph nodes as well as in the lung parenchyma, myocardium and several other organs.

Conclusion: The cardiac involvement of previously undiagnosed systemic sarcoidosis was the cause of sudden death. In case of ECG changes of unknown cause in persons without a history of structural cardiac disease sarcoidosis should be considered in the differential diagnosis.