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Makhdumi M, Assar MD, Meyer DM, Roberts WC. Cardiac sarcoidosis diagnosed after orthotopic heart transplantation and clinically mimicking arrhythmogenic right ventricular cardiomyopathy. Cardiovasc Pathol 2021; 56:107390. [PMID: 34600147 DOI: 10.1016/j.carpath.2021.107390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Described herein is a 71-year-old man who underwent orthotopic heart transplant (OHT) for chronic severe heart failure secondary to cardiac sarcoidosis (CS) devoid of non-caseating granulomas but nevertheless characteristic of CS. Clinically, his heart disease had suggested the presence of arrhythmogenic right ventricular cardiomyopathy.
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Affiliation(s)
- Madiha Makhdumi
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, United States
| | - Manish D Assar
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, United States; Internal Medicine, Baylor University Medical Center, Dallas, Texas, United States
| | - Dan M Meyer
- Departments of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas, United States; Internal Medicine, Baylor University Medical Center, Dallas, Texas, United States
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, United States; Internal Medicine, Baylor University Medical Center, Dallas, Texas, United States.
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Biggs R, Patel B, Martinez MW, McCambridge M, Kim S, Marcus N. Cardiac sarcoidosis mimicking arrhythmogenic right ventricular dysplasia in a patient presenting with monomorphic ventricular tachycardia. HeartRhythm Case Rep 2017; 3:418-421. [PMID: 28948146 PMCID: PMC5601329 DOI: 10.1016/j.hrcr.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ross Biggs
- Division of Internal Medicine, Lehigh Valley Hospital Network, Allentown, Pennsylvania
| | - Brijesh Patel
- Division of Cardiology, Lehigh Valley Hospital Network, Allentown, Pennsylvania
| | - Matthew W. Martinez
- Division of Cardiology, Lehigh Valley Hospital Network, Allentown, Pennsylvania
| | - Matthew McCambridge
- Division of Pulmonary/Critical Care, Lehigh Valley Hospital Network, Allentown, Pennsylvania
| | - Susan Kim
- Division of Rheumatology, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Norman Marcus
- Division of Cardiology, Lehigh Valley Hospital Network, Allentown, Pennsylvania
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Cohen Aubart F, Nunes H, Mathian A, Haroche J, Hié M, Le-Thi Huong Boutin D, Cluzel P, Soussan M, Waintraub X, Fouret P, Valeyre D, Amoura Z. [Cardiac sarcoidosis: Diagnosis and therapeutic challenges]. Rev Med Interne 2016; 38:28-35. [PMID: 27211064 DOI: 10.1016/j.revmed.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 03/06/2016] [Accepted: 03/14/2016] [Indexed: 12/16/2022]
Abstract
Sarcoidosis is a granulomatous disorder of unknown cause characterized by non-caseating granuloma in young adults. Cardiac involvement is rare and range from 2 to 75% depending on diagnostic criteria. Cardiac involvement in sarcoidosis may be asymptomatic or may manifest as rhythm/conduction troubles or congestive heart failure. The diagnosis and treatment of cardiac sarcoidosis may be challenging. However, advances have come in recent years from the use of cardiac MRI and 18FDG-TEP scanner, as well as from the stratification of the risk of ventricular tachycardia/fibrillation. Due to the rarity of the disease, there is no reliable prospective large study to guide therapeutic strategy for cardiac sarcoidosis. Corticosteroids are probably efficacious, in particular in case of atrio-ventricular block or moderate heart failure. Immunosuppressive drugs have not been largely studied but methotrexate could be helpful. In refractory forms, TNF-α antagonists have been used with success.
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Affiliation(s)
- F Cohen Aubart
- Service de médecine interne, institut E3M, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Paris VI Pierre-et-Marie-Curie, Sorbonne universités, 75013 Paris, France.
| | - H Nunes
- Service de pneumologie, hôpital Avicenne, AP-HP, université Paris XIII, 93000 Bobigny, France
| | - A Mathian
- Service de médecine interne, institut E3M, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Paris VI Pierre-et-Marie-Curie, Sorbonne universités, 75013 Paris, France
| | - J Haroche
- Service de médecine interne, institut E3M, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Paris VI Pierre-et-Marie-Curie, Sorbonne universités, 75013 Paris, France
| | - M Hié
- Service de médecine interne, institut E3M, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - D Le-Thi Huong Boutin
- Service de médecine interne, institut E3M, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Paris VI Pierre-et-Marie-Curie, Sorbonne universités, 75013 Paris, France
| | - P Cluzel
- Université Paris VI Pierre-et-Marie-Curie, Sorbonne universités, 75013 Paris, France; Service de radiologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - M Soussan
- Service de médecine nucléaire, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - X Waintraub
- Service de cardiologie, unité de rythmologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - P Fouret
- Université Paris VI Pierre-et-Marie-Curie, Sorbonne universités, 75013 Paris, France; Service d'anatomo-pathologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - D Valeyre
- Service de pneumologie, hôpital Avicenne, AP-HP, université Paris XIII, 93000 Bobigny, France
| | - Z Amoura
- Service de médecine interne, institut E3M, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Paris VI Pierre-et-Marie-Curie, Sorbonne universités, 75013 Paris, France
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Vakil K, Minami E, Fishbein DP. Right ventricular sarcoidosis: is it time for updated diagnostic criteria? Tex Heart Inst J 2014; 41:203-7. [PMID: 24808785 DOI: 10.14503/thij-12-3086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A 55-year-old woman with a history of complete heart block, atrial flutter, and progressive right ventricular failure was referred to our tertiary care center to be evaluated for cardiac transplantation. The patient's clinical course included worsening right ventricular dysfunction for 3 years before the current evaluation. Our clinical findings raised concerns about arrhythmogenic right ventricular cardiomyopathy. Noninvasive imaging, including a positron emission tomographic scan, did not reveal obvious myocardial pathologic conditions. Given the end-stage nature of the patient's right ventricular failure and her dependence on inotropic agents, she underwent urgent listing and subsequent heart transplantation. Pathologic examination of the explanted heart revealed isolated right ventricular sarcoidosis with replacement fibrosis. Biopsy samples of the cardiac allograft 6 months after transplantation showed no recurrence of sarcoidosis. This atypical presentation of isolated cardiac sarcoidosis posed a considerable diagnostic challenge. In addition to discussing the patient's case, we review the relevant medical literature and discuss the need for updated differential diagnostic criteria for end-stage right ventricular failure that mimics arrhythmogenic right ventricular cardiomyopathy.
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Affiliation(s)
- Kairav Vakil
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington 98195
| | - Elina Minami
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington 98195
| | - Daniel P Fishbein
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington 98195
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Roberts WC, Chung MS, Ko JM, Capehart JE, Hall SA. Morphologic features of cardiac sarcoidosis in native hearts of patients having cardiac transplantation. Am J Cardiol 2014; 113:706-12. [PMID: 24393258 DOI: 10.1016/j.amjcard.2013.11.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/09/2013] [Accepted: 11/09/2013] [Indexed: 11/27/2022]
Abstract
Described herein are 10 patients who underwent cardiac transplantation (CT) for severe chronic systolic heart failure resulting from cardiac sarcoidosis. None had the diagnosis of sarcoidosis established before CT except for the 3 patients who earlier had had a portion of left ventricular wall excised for insertion of a left ventricular assist device and non-caseating granulomas were present in the removed myocardium. Although none of the 10 patients had significant narrowing of any of the epicardial coronary arteries, all had focal scarring of the walls of the left and right ventricles and ventricular septum and all had dilated ventricular cavities. The patients with the most ventricular wall scarring tended to have the fewest sarcoid granulomas in the ventricular walls. Two patients had no sarcoid granulomas in the excised heart although one did have typical sarcoid granulomas in the portion of left ventricular wall excised to insert a left ventricular assist device. Patients with cardiac sarcoidosis severe enough to warrant CT had characteristic cardiac ventricular morphologic findings, and no dysfunction of other non-cardiac organs, making clinical diagnosis of cardiac sarcoidosis rather difficult.
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Maggio LA, Steinberg RM, Moorhead L, O'Brien B, Willinsky J. Access of primary and secondary literature by health personnel in an academic health center: implications for open access. J Med Libr Assoc 2013; 101:205-12. [PMID: 23930091 DOI: 10.3163/1536-5050.101.3.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The research sought to ascertain the types and quantity of research evidence accessed by health personnel through PubMed and UpToDate in a university medical center over the course of a year in order to better estimate the impact that increasing levels of open access to biomedical research can be expected to have on clinical practice in the years ahead. METHODS Web log data were gathered from the 5,042 health personnel working in the Stanford University Hospitals (SUH) during 2011. Data were analyzed for access to the primary literature (abstracts and full-text) through PubMed and UpToDate and to the secondary literature, represented by UpToDate (research summaries), to establish the frequency and nature of literature consulted. RESULTS In 2011, SUH health personnel accessed 81,851 primary literature articles and visited UpToDate 110,336 times. Almost a third of the articles (24,529) accessed were reviews. Twenty percent (16,187) of the articles viewed were published in 2011. CONCLUSION When it is available, health personnel in a clinical care setting frequently access the primary literature. While further studies are needed, this preliminary finding speaks to the value of the National Institutes of Health public access policy and the need for medical librarians and educators to prepare health personnel for increasing public access to medical research.
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Zacek P, Omran N, Chek JL, Krbal L, Vojacek J, Harrer J. Cardiac Sarcoidosis. J Card Surg 2013; 28:525-8. [DOI: 10.1111/jocs.12163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Pavel Zacek
- Faculty of Medicine and Faculty Hospital, Department of Cardiac Surgery; Charles University in Prague; Hradec Kralove Czech Republic
| | - Nedal Omran
- Faculty of Medicine and Faculty Hospital, Department of Cardiac Surgery; Charles University in Prague; Hradec Kralove Czech Republic
| | - James L. Chek
- Faculty of Medicine and Faculty Hospital, Department of Cardiac Surgery; Charles University in Prague; Hradec Kralove Czech Republic
| | - Lukas Krbal
- Faculty of Medicine and Faculty Hospital, The Fingerland's Department of Pathology; Charles University in Prague; Hradec Kralove Czech Republic
| | - Jan Vojacek
- Faculty of Medicine and Faculty Hospital, Department of Cardiac Surgery; Charles University in Prague; Hradec Kralove Czech Republic
| | - Jan Harrer
- Faculty of Medicine and Faculty Hospital, Department of Cardiac Surgery; Charles University in Prague; Hradec Kralove Czech Republic
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