Heart block resulting from myocardial sarcoidosis.

Abstract

The clinical and pathologicalfindings in a 6o-year-old man with complete heart block are described. He died as a result of pacemaker failure, and necropsy showed massive myocardial involvement by sarcoidosis which had destroyed the atrioventricular node and upper part of the bundle of His. He was found to be in complete heart block with a heart rate of 40 per minute. There were no signs of cardiac failure, the heart was not clinically enlarged, and there were no cardiac murmurs. Blood pressure was 140/70 mmHg. The liver, spleen, and lymph nodes were not enlarged, and there were no rashes. Except for diffuse enlargement of the prostate, the rest of the examination was normal.The electrocardiogram showed complete heart block with a ventricular rate of 40 a minute, and a QRS pattern of left anterior hemiblock and right bundle-branch block. The chest x-ray showed slight cardiac enlargement, but the lung fields were normal and mediastinal lymph node enlargement could not be seen. The full blood count, erythrocyte sedimentation rate, blood electrolytes, and blood urea were normal. A trace of albumin was present in the urine, but urine microscopy and culture showed no abnormality.A pacemaker was inserted, pacing being carried out by the endocardial route with a St. George's catheter electrode, and a fixed rate Devices Thin Film pacemaker (type 382I). In October I97I a prostatectomy was uneventfully carried out.After his prostatectomy he was asymptomatic, and pacing tests on the 28 October 1971 showed satisfactory pacing and pacemaker function. However, on the 22 December 197I, he died suddenly while sitting at home after a day's shooting. The pacemaker was removed at necropsy and was found to have failed. NecropsyThe body was that of a well-nourished elderly man and there were no significant external findings. The pacemaker coil was implanted in the anterior abdominal wall; the catheter ran up to the right jugular vein and down into the apex of the right ventricle, and was intact throughout its length. The lungs showed small old calcified tuberculous lesions at the apex of both lungs but no other abnormalities. The lymph nodes around both main bronchi were enlarged (largest 2 X 2 X IP5 cm) and had a fleshy texture. The heart, 490 g, showed numerous white fleshy nodules involving the walls of all the cavities, but the left ventricular wall and interventricular septum were most severely involved, with nodules up to 3-5 X 3 X I-5 cm (Fig. I).The upper part of the interventricular septum was infil-

Atrioventricular Block as the Initial Manifestation of Cardiac Sarcoidosis in Middle‐Aged Adults

“…CS may result in AVB, ventricular tachycardia (VT), heart failure (HF), and sudden cardiac death . Conduction abnormalities occur due to involvement of the basal interventricular septum and may result in bundle branch block or AVB of any degree …”

Arrhythmias in cardiac sarcoidosis

“…Third-degree atrioventricular block (complete heart block, CHB) is the most common, affecting up to 30% of patients [3,[23][24][25][26][27]. Third-degree atrioventricular block (complete heart block, CHB) is the most common, affecting up to 30% of patients [3,[23][24][25][26][27].…”

Syncope in young

“…Though left ventricular free wall is the most common location, interventricular septum is frequently affected in sarcoidosis. The focal granuloma interrupts the cardiac conduction system in one-third of symptomatic patients 2. It may manifest as various types of atrioventricular conduction defects, bundle branch blocks, different ventricular and supraventricular arrhythmias and sudden cardiac deaths.…”