Sarcoidosis

Report:

Sinus tachycardia 118/min

PR interval 0.20”

Right axis deviation

Alternating (2:1) right bundle branch block

Nonspecific ST/T changes

Possible lateral infarction ?age

Comment:

The tracing, of course, provides scant clues to its provenance. Clinically, the patient had congestive cardiomyopathy, with history of cerebral disease her neurologist, with unusual perspicacity or luck, thought might be sarcoid. This proved to be the case, on other grounds. She eventually had endomyocardial biopsy that proved cardiac involvement, said to be present in 20 –25% cases40.

AV and ventricular blocks are common, while pathological Q waves are not rare; looking at this trace one would be, perhaps, justified in thinking that there are not enough Q waves to produce an almost ‘trifascicular’ block, should the latter’s ætiology be ischæmic. Once sarcoidosis is confirmed elsewhere, this ECG becomes quite typical.

Below (Fig 36a) is a trace taken 2 days later, in RBBB throughout, and another, in 4:3 RBBB (Fig 36b).

36a.

36b. 37. Retarded 28 year old hydrocephalic with one week’s history of weakness and œdema