Ventricular tachycardia – an unusual presentation of a systemic disease

Introduction: Cardiac manifestations in sarcoidosis are found in less than 5% of the cases, most patients presenting with pulmonary panel (50%). The clinical presentation with ventricular tachycardia as the first manifestation, although very rare, may be possible. Case Presentation: This is the case of a patient aged 53, with multiple cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity), who presented for palpitations lasting about 20 minutes, accompanied by shortness of breath and chest pain,hemodynamically well tolerated without apparent triggers arising 3days prior to submission. The patient denied a history of dyspnea or angina. As the first episode of its kind in patient’s history, it was decided the admission for further investigations to determine the etiology of palpitations. Note that admission ECG was normal, but chest radiography reveals right hilar lymphadenopathy, normal serum ionogram, TSH and renal function. After 2 days of admission patient experiences palpitations occurring at rest, ECG revealed sustained monomorphic ventricular tachycardia with a pattern of right bundle branch block, which respondes to amiodarone. Echocardiography is normal and coronarography does not indicate lesions of epicardial coronary arteries. Electrophysiological study was performed, which in duces monomorphic VT when positioning the catheter at the right ventricle apex, septal. It is recommended further investigations by cardiac MRI, which is not suggestive for ARVD or other structural cardiomyopathy but indicates an area of scar/fibrosis in the infero-lateral basal segment. Given the coexistence of hilar lymphadenopathy and concomitant heart disease it is raised the suspicion of sarcoidosis with cardiac involvement so the patient has indication for further investigations. It is performed chest CT and mediastinal lymph nodes biopsy, highlighting non-necrotizing granulomatous lymphadenitis, lesions consistent with the diagnosis of sarcoidosis. Diagnosis: Sarcoidosis with cardiac and lymphatic involvement. Monomorphic ventricular tachycardia remitted therapeutically. Hypertension. Diabetes. Discussion: Sarcoidosis is a systemic disease rarely presenting cardiac manifestations, especially in cases of coexistance with pulmonary manifestations . One of the clinical manifestations of cardiac sarcoidosis is the ventricular tachycardia. The particularity of the case is the absence of parenchymal lung damage and VT presence in a patient with coronary risk factors but normal epicardial coronary arteries.

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