title: [Heart failure as a cardiac symptom of sarcoidosis. Successful treatment of heart failure with steroids, digitalis and an angiotensin-1-receptor antagonist in sarcoidosis].
abstract: BACKGROUND
  Sarcoidosis is a multisystemic disorder that may involve every organ. A symptomatic manifestation of the myocardium is possible, in these cases arrhythmias are the most common symptoms.
  
  
  METHODS
  This case report presents a 26-year-old female with the recurrence of Boeck's sarcoid. Fever, chill and a severe reduction in stress tolerance were the first symptoms. At the time of admission she complained of Grade III dyspnea according to the NYHA classification. The echocardiogram showed a severe impairment of the global and left ventricular function. The left ventricular ejection fraction was reduced to 30% and the Tei index was elevated to 1.0. A specimen taken from a mediastinal tumor confirmed the hypothesis of the recurrence of the sarcoidosis. Myocardial perfusion scintigraphy showed typical lesions for myocardial sarcoidosis. There were signs of an old anteroseptal infarction in the resting ECG without evidence of myocardial ischemia during a stress test. Repeated Holter-ECGs were without signs of severe arrhythmias whereas ventricular late potentials were positive. After the combined therapy with steroids, digitalis and an angiotensin-1 receptor antagonist, mediastinal mass and Tei index were reduced and the ejection fraction moved to 56%. Dyspnoea was classified with Grade II according to the NYHA classification.
  
  
  CONCLUSIONS
  Treatment of asymptomatic sarcoidosis is still controversial, whereas the treatment of life-threatening sarcoidosis, eye involvement or severe hypercalcemia is accepted. This case report presents the successful treatment of severe heart failure with prednisone, glycosides and an angiotensin-1 receptor antagonist. With this combined therapy an improvement of subjective and objective parameters was possible.
authors.affiliation: Abteilung für Kardiologie, Universitätsklinikum Essen. olaf.oldenburg@uni-essen.de
authors.forename: O
authors.initials: O
authors.lastname: Oldenburg
authors.forename: R F
authors.initials: RF
authors.lastname: Schäfers
authors.forename: S
authors.initials: S
authors.lastname: Kuntz
authors.forename: S
authors.initials: S
authors.lastname: Sack
authors.forename: R
authors.initials: R
authors.lastname: Erbel
authors.forename: T
authors.initials: T
authors.lastname: Philipp
authors.forename: F
authors.initials: F
authors.lastname: Weber
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004074:Digitoxin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D019808:Losartan / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D014463:Ultrasonography
chemical_list: D000889:Anti-Arrhythmia Agents; D000893:Anti-Inflammatory Agents; D004074:Digitoxin; D019808:Losartan; D011241:Prednisone