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• W3092935575 abstract "SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Sarcoidosis is a multi-organ, immune-mediated systemic disorder of unknown etiology, characterized by non-caseating epithelioid granulomas. Cardiac involvement is seen in only 5% of patients with systemic sarcoidosis and is often undetected clinically. We present a middle-aged man with new-onset atrial fibrillation found to have cardiac sarcoidosis. CASE PRESENTATION: 46-year-old male presented with acute onset of palpitations without any significant hemodynamic changes. Past medical history included sarcoidosis diagnosed by chest radiography without prior histological confirmation or treatment; gallium scan had no cardiac involvement. He had previous military service in Iraq with no reported exposure to burn pits, radiation, or beryllium. Physical exam showed no evidence of adenopathy, peripheral or ophthalmologic sarcoidosis, and cardiac exam revealed regular rhythm with no appreciable murmur. Comprehensive metabolic panel, complete blood count, inflammatory markers, ANA, rheumatoid factor, immune panel, fungal serology, and HIV labs were normal. EKG was normal sinus rhythm with left axis deviation. Transthoracic echocardiogram showed normal valvular function and ejection fraction. Ziopatch demonstrated underlying sinus rhythm, atrial fibrillation (4% burden) with the longest episode lasting 3 hours, 296 short episodes of supraventricular tachycardia lasting up to 28 seconds, and about 2 minutes of ventricular trigeminy. No long pauses, heart block, or sustained ventricular arrhythmias were noted. The patient had 29 triggered events, which occurred predominantly during episodes of atrial fibrillation and supraventricular tachycardia. Cardiac MRI showed patchy myocardial lesions and CT chest found multiple scattered, upper lobe predominant peri-lymphatic nodules. Transbronchial biopsies from the right upper lobe ultimately revealed interstitial fibrosis with non-necrotizing granulomas. The patient was discharged with steroids, a beta-blocker, and anticoagulation with close outpatient follow-up. DISCUSSION: This case illustrates how sub-clinical, untreated sarcoidosis can eventually present as symptomatic atrial fibrillation with significant cardiac involvement. Cardiac sarcoidosis more commonly presents as atrioventricular block, left-sided heart failure, or syncope. However, up to 27% of autopsies of patients with asymptomatic sarcoidosis demonstrate myocardial involvement. CONCLUSIONS: This case is meant to raise awareness for potential cardiac damage even in the absence of clinical sarcoidosis, and further screening guidance may be needed to improve earlier identification of cardiac sarcoidosis. Reference #1: Golwala H, Dernaika T. Atrial fibrillation as the initial clinical manifestation of cardiac sarcoidosis: a case report and review of the literature. Journal of Cardiovascular Medicine. 2015; 16:104-112. Ipek E, Demierelli S, Ermis E, Inci S. Reference #2: Sarcoidosis and the heart: a review of the literature. Intractable Rare Diseases Research. 2015; 4(4): 170-180. Reference #3: Degtiarova G, Gheysens O, Van Cleemput J, Wuyts W, Bogaert J. Natural evolution of cardiac sarcoidosis in an asymptomatic patient: a case report. European Heart Journal – Case Reports. 2019; 3:3. DISCLOSURES: No relevant relationships by Rohanna Edwards, source=Web Response No relevant relationships by Nazir Memon, source=Web Response No relevant relationships by Byron Mitchell, source=Web Response No relevant relationships by Perry Nystrom, source=Web Response No relevant relationships by Dawn Russell, source=Web Response No relevant relationships by Joy Wang, source=Web Response No relevant relationships by Steven Young, source=Web Response" @default.
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• W3092935575 date "2020-10-01" @default.
• W3092935575 modified "2023-09-27" @default.
• W3092935575 title "ATRIAL FIBRILLATION EXPOSES CARDIAC SARCOIDOSIS" @default.
• W3092935575 doi "https://doi.org/10.1016/j.chest.2020.08.204" @default.
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