Exercise-induced torsades de pointes as an unusual presentation of cardiac sarcoidosis: A case report and review of literature

作     者：Chadi Ghafari Frédéric Vandergheynst Emmanuel Parent Kaoru Tanaka Stéphane Carlier 

作者机构：Department of CardiologyCentre Hospitalier Universitaire Ambroise ParéMons 7000Belgium Department of CardiologyUniversitéde MonsMons 7000Belgium Department of Internal MedicineCliniques Universitaires de Bruxelles-ErasmeBruxelles 1070Belgium Department of CardiologyUniversitair Ziekenhuis BrusselsJette 1090Belgium 

出 版 物：《World Journal of Cardiology》 (世界心脏病学杂志（英文版）（电子版）)

年 卷 期：2020年第12卷第6期

页      面：291-302页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Sarcoidosis Cardiac sarcoidosis Torsades de pointes Ventricular tachycardia Immunotherapy Case report 

摘      要：BACKGROUND Sarcoidosis is a rare multisystem disease characterized histologically by noncaseating granuloma formation in the affected *** cardiac sarcoidosis is found on autopsy in up to 25%of sarcoidosis cases,it is still underdiagnosed and is associated with a poor *** the etiology of sarcoidosis remains unclear,an antigen triggered exaggerated immune response has been *** detection and prompt management of cardiac sarcoidosis remains *** SUMMARY A 60-year-old female,with pulmonary sarcoidosis in remission,presented to the cardiology outpatient clinic for evaluation of weeks-long dyspnea on moderate exertion(New York Heart Association class II)that was relieved by *** exercise stress test showed multifocal ventricular extrasystoles,followed by a self-limiting torsades de *** magnetic resonance imaging showed nondilated and normotrophic left ventricle with basoseptal and mid-septal *** magnetic resonance imaging-derived left ventricular ejection fraction was 45%.Delayed enhancement showed patchy transmural fibrosis of the septum and hyperenhancement of the papillary muscles,all in favor of extensive cardiac involvement of sarcoidosis.A double-chamber implantable cardiac defibrillator was implanted,and methylprednisolone(12 mg/d)and methotrexate(12.5 mg/wk)treatment was ***-up and implantable cardiac defibrillator interrogation showed episodes of asymptomatic nonsustained ventricular tachycardia and an asymptomatic episode of nonsustained ventricular tachycardia ending by the first antitachycardia pacing *** Along an extensive review of the literature,this unusual case report highlights the importance of early detection of cardiac involvement of sarcoidosis,in order to avoid potential complications and increase survival.