Sarcoidosis is a systemic inflammatory disease characterized by the presence of noncaseating granulomas. Etiology of the disease remains unknown. From 3.7% to 54.9% patients with extra-cardiac sarcoidosis have asymptomatic heart involvement. Conduction abnormalities, arrhythmias and congestive heart failure are the most common clinical manifestations of cardiac sarcoidosis (CS). The aim of the study was to evaluate the type and frequency of electrocardiographic abnormalities in patients with pulmonary sarcoidosis and to compare differences in the occurrence of electrocardiographic changes between patients diagnosed with CS and patients without confirmation of CS. Materials and methods: 49 patients (18 women, 31 men), mean age 45.6 ±12.2 years with biopsy-proven pulmonary sarcoidosis were enrolled in the study. The patients were divided into two groups. Group 1 consisted of 12 patients diagnosed with CS, and Group 2 of 37 patients without diagnosis of CS. 12-lead baseline electrocardiogram (ECG) was recorded for all participants. Results: 89.8% patients with pulmonary sarcoidosis had abnormal ECG. The most common ECG abnormalities were ST-T changes observed in 79.6%. Conduction abnormalities were present in 26.5% of patients. 22.45% patients had left axis deviation. Rhythm abnormalities were recorded in 20.4% of all analyzed ECGs. ECGs of 8.16% of patients met criteria of hypertrophy. There was a trend towards more frequent prevalence of some ECG changes in patients with CS than patients without CS. However, these differences were not statistically significant. Conclusions: We observed a trend towards more frequent prevalence of some ECG abnormalities in a group of patients with CS than in patients without CS. However, these differences were not statistically significant. ECG abnormalities in patients with pulmonary sarcoidosis require further diagnostics. JRCD 2017; 3 (3): 81-85
Improvement of the long-term survival of patients with Tetralogy of Fallot has been observed in the last few years. Among the late complication arrhythmias are detected most frequently. The aim of this study was to estimate the frequency of atrial and ventricular arrhythmias in the group of 53 adult tetralogy patients.Mean age was 29 years, 21 patients (39,6%) were women. In 4 cases (7,5%) palliative pulmonary-systemic shunt was performed. Average age of total surgical correction was 6,55 years. Significant ventricular arrhythmias were present in 15 patients (28,3%). 9 (17%) had relevant atrial arrhythmias. Patients with atrial arrhythmia were older (35,4 vs 27,7 years). Older were also patients with ventricular arrhythmias (34,7 vs 26,4 years). Group with atrial arrhythmia used more digoxin (p=0,002) and diuretics (p = 0,021). 3 patients on oral anticoagulants had atrial flutter. Similar data was collected in group with ventricular arrhythmias (diuretics p = 0,0053). There was a high incidence of coexisting ventricular and atrial arrhythmias (p=0,0057). Left ventricular enlargement was present in patients with atrial (p = 0,002) and ventricular (p = 0,027) arrhythmias. Right atrium area and left atrium diameter were greater in group with supraventricular arrhythmias (31,6 vs 21,6 cm 2 and 40,4 vs 34,3 mm; respectively). Ventricular arrhythmias were associated with greater right (27,8 vs 21,0 cm 2 ) and left atrium areas (18,5 vs 15,1 cm 2 ).Younger age at the time of corrective surgery is associated with lower frequency of arrhythmias in adults. Arrhythmias however remain one of the most significant problems in this group of patients. Close observation in centers specialized in Grown-Up Congenital Heart Defects and management of symptoms seems to be the best option in long-term follow-up.
52-year-old Caucasian man was admitted with clinical symptoms of chronic heart failure. Constrictive pericarditis was suspected almost 9 years before admission, but patient refused to under go diagnostic evaluation. Peripheral oedema, ascites, hepatomegaly, increased jugular veins pressure and pleural effusion were present on admission. Laboratory test showed increased level of brain natriuretic peptide with normal levels of liver enzymes and total bilirubin. Chest X-ray revealed calcifications of pericardium. In echocardiography biatrial enlargement was present with septal bounce, dilated inferior vena cava, respiratory variation of mitral and tricuspid inflow. Computed tomography showed massive calcifications of pericardium and hydrothorax of both pleural cavities. Cardiac magnetic resonance confirmed enlargement of both artia with dyssynchrony of intraventricular septum and pericardium thickening. Cardiac catheterization confirmed diagnosis of constrictive pericarditis. Patient was qualified for pericardiectomy. He died during procedure due to bleeding complications. According to ESC Guidelines, pericardiectomy is the treatment of choice in patients with significant symptoms with mortality rate 6-12%. JRCD 2015; 2 (5): 161-164
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