title: Heart block: a primary manifestation of sarcoidosis.
abstract: We present the case of a 55-year-old male who presented with symptoms of dyspnoea and pre-syncope. A 12 lead electrocardiogram demonstrated extensive conduction abnormalities with 2:1 heart block, right bundle branch block and a small Q wave in lead V(1.) This indicated significant myocardial and septal involvement. Echocardiography confirmed the presence of right ventricular infiltration and dysfunction whilst cardiac magnetic resonance showed the infiltration to be nodular in nature. Although a diagnosis of cardiac sarcoidosis and lymphoma were initially considered, sarcoidosis was eventually confirmed following a cervical lymph node biopsy. This case firstly demonstrates the usefulness of the 12-lead electrocardiogram in determining the likely anatomical locality of significant bradyarrhythmias. Secondly it highlights the difficulties in diagnosing cardiac sarcoidosis when cardiac dysfunction is the sole manifestation of the disease.
authors: Department of Cardiology, Sussex Cardiac Centre, Brighton BN2 5BE, UK. dr.r.rajani@gmail.com
authors: Ronak
authors: R
authors: Rajani
authors: Sanjay
authors: S
authors: Prasad
authors: Sean
authors: S
authors: O'Nunain
authors: Manav
authors: M
authors: Sohal
authors: Azad
authors: A
authors: Ghuran
mesh_terms: D001706:Biopsy; D002037:Bundle-Branch Block / Q000209:etiology / Q000503:physiopathology; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D004562:Electrocardiography; D006327:Heart Block / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012507:Sarcoidosis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology