Background
Myocardial involvement in sarcoidosis may be benign, or in some instances may be life-threatening. We report 2 cases of high degree AV Block associated with systemic sarcoidosis.
Purpose
To raise awareness of cardiac involvement in sarcoidosis and its clinical implications.
Patients and Materials
Patient 1 A 43-year-old male presented Stokes-Adams syndrome, related to transient complete heart block which required cardio-pulmonary resuscitation. He was treated by a temporary pacemaker, and shortly after, a permanent pacemaker was implanted. On a chest X-ray, CT and Gallium-scan there was evidence of hilar and axillar lymphadenopathy. The diagnosis of sarcoidosis was confirmed by mediastinal lymph node biopsy.
Patient 2 A 58-year-old female, followed for hyperlipidemia and pulmonic sarcoidosis, presented two years earlier by cough and dyspnea. At that time chest CTscan demonstrated enlarged mediastinal lymph-nodes. Lymph node biopsy showed non- caseating granulomas. Recently the patient presented with fatigue, dizziness and almost syncope, secondary to a high degree AV block ,with no evidence of cardiac ischemia. A permanent pacemaker was implantated. Prior to the implantation there was no evidence of inducible tachyarrhythmia ,on an EPS study.
Conclusions
We present two patients with cardiac sarcoidosis presented with high degree AV Block, who needed pacemaker therapy. One was known as suffering from pulmonary sarcoidosis, and in the second case , the diagnosis was established during the recent event. Our case reports aim to increase awareness of cardiac sarcoidosis ,as a possible cause of syncope and sometimes cardiac arrest. It is recommended that pts with sarcoidosis should undergo early screening for cardiac involvement , by different modalities, and thus save lives.
