Heart failure as a cardiac manifestation of sarcoidosis. Successful treatment of heart failure with steroids, digitalis, and an angiotensin-1 receptor antagonist

Background: Sarcoidosis is a multisystemic disorder that may involve every organ. A symptomatic manifestation of the myocardium is possible, in these cases arrhythmia are the most common symptoms. Case Report: This case report presents a 26-year-old female with the recurr ence of Boeck's sarcoid. Fever, chill and a severe reduction in stress tole rance were the first symptoms. At the time of the admission she complained of Grade III dyspnea according to the NYHA classification. The echocardiogr am sowed a severe impairment of the global and left ventricular function. T he left ventricular ejection fraction was reduced to 30% and the Tei index was elevated to 1,0. A specimen taken from a mediastinal tumor confirmed th e hypothesis of the recurrence of the sarcoidosis. Myocardial perfusion sci ntigraphy showed typical lesions for myocardial sarcoidosis. There were sig ns of an old anteroseptal infarction in the resting ECG without evidence of myocardial ischemia during a stress test. Repeated Holter-ECGs were withou t signs of severe arrhythmias whereas ventricular late potentials were posi tive. After the combined therapy with steroids, digitalis and an angiotensi n-1 receptor antagonist, mediastinal mas and Tei index were reduced and the ejection fraction moved to 56%. Dyspnoe was classified with Grade II accor ding to the NYHA classification. Conclusion: Treatment of asymptomatic sarcoidosis is still controversial, w hereas the treatment of life-threatening sarcoidosis, eye involvement or se vere hypercalcemia is accepted. This case report presents the successful tr eatment of severe heart failure with prednisone, glycosides and an angioten sin-1 receptor antagonist. With this combined therapy an improvement of sub jective and objective parameters was possible.