S.A.M. Said*, S. Post, R. de Nooijer, R. Nijhuis, H.H.D. Idzerda, J.W. op den Akker, O. Kessels, N.R.L. Wagenaar, A. Agool, C.D. Heymans
Aim: To describe the non-invasive multi-imaging options in patients who develop ventricular, supraventricular arrhythmias and conduction defects as a manifestation of cardiac sarcoidosis (CS) with biopsy documented systemic sarcoidosis.
Method: We report four cases of patients with extra-cardiac sarcoidosis presented with different manifestations of CS.
Results: CS was presented by ventricular tachycardia, total AV block, paroxysmal atrial fibrillation, persistent atrial flutter, complete right bundle branch block and multifocal PVC’s. Moderate diastolic dysfunction (DD) was detected on echocardiography in one patient and mild DD in two patients. Systemic sarcoidosis was histologically and/or cytologically confirmed in all patients. No endomyocardial biopsy was performed. 18F-fluorodeoxyglucose positron emission tomography (FDG PET) was performed in three patients and cardiovascular magnetic resonance imaging (cMRI) was undertaken in 3. Merging of FDG PET with cMRI images revealed inflammatory activity at the sites of late gadolinium enhancement (LGE). All subjects were treated medically with a combination of prednisolone and methotrexate or azathioprine. A dual chamber implantable cardioverter-defibrillator (ICD) was implanted in three patients and the fourth received a dual chamber pacemaker. Transthoracic echocardiography findings of diastolic dysfunction were detected in one patient.
Conclusions: Non-invasive multi-imaging diagnostic approach is useful in patients with biopsy-proven extra-cardiac sarcoidosis who develop conduction disorder, supraventricular or ventricular tachyarrhythmias to confirm cardiac involvement and monitor treatment.
Wilson Onuigbo*, Deirdre Twomey
Concerning the Igbos of South-Eastern Nigeria, a series 6 cases was published with reference to vulval carcinoma-in-situ. Therefore, it is of interest that only one case of this type occurred in the vagina during the same period. The relevant epidemiological matters were discussed including the mean age of about 55 years.
Lawrence M. Agius*
Propositional events as injurious agonists attest to the progression of an injury that is repetitively re-duplicated within the cardiovascular system as a whole. In such terms the equivalent dimensions of the reproduction of the signal atherosclerotic plaque are further compounded by the dimensional re-distribution of integral lesions that mirror-image the consequences of lipid deposition and of accumulation of foam cells as projected by a generic and ongoing inflammatory series of vascular reactivities. Performance attributes of pathogenesis are incremental systems for further propositional conditioning within reactivation formulas of the inflammatory process as induced within systems of profile determination of the atherogenesis phenomenon.
Biocore Publishing Group
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