首页|Heart block in a 60-year-old man with undiagnosed cardiac sarcoidosis
Heart block in a 60-year-old man with undiagnosed cardiac sarcoidosis
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NSTL
Cma-Canadian Medical Assoc
A 60-year-old man presented to the emergency department after a brief syncopal episode without a prodrome. The patient was alert and oriented after the episode, and witnesses reported no seizure activity. He had no history of syncope, but did have a history of hypertension and left nephrectomy (he was an elective donor). His only medication was amlodipine 5 mg/d orally. He had no allergies and was a half-pack-per-day smoker. He did not use marijuana, alcohol or illicit drugs. His heart rate was 35-40 beats/min and blood pressure was 190/80 mmHg. His temperature, oxygen saturation and respiratory rate were normal, as was the remainder of the physical examination. An electrocardiogram (ECG) showed 2:1 atrioventricular (AV) block with left bundle branch block (Figure 1). No previous ECGs were available. Chest radiograph was normal. The patient had a normal complete blood count, electrolytes, renal function, liver enzymes and thyroid-stimulating hormone level, which ruled out electrolyte abnormalities and thyroid disease as a cause of heart block. High-sensitivity troponin-T levels were mildly elevated (23, 60, 84 [reference range 0-14] ng/L). We admitted him for further investigations including C-reactive protein levels, immunoglobulins, vasculitis panel, blood cultures and Lyme serology, and all were negative. Thus, we considered it unlikely that his heart block was caused by infectious or autoimmune diseases (Box 1).
Ashar Pirzada、Andrew D. Moeller
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Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, NS
NSTL
Cma-Canadian Medical Assoc
