Torsades de pointesを呈した心サルコイドーシスの1例

A case of cardiac sarcoidosis with various electrocardiographic change

　サルコイドーシスは原因不明の慢性類上皮細胞肉芽腫であり，約70％の症例は自然治癒する予後良好な疾患である。

　しかし，5〜10％は心臓，中枢神経，肺に浸潤し死亡すると言われている^1,2）。

The patient was a 61 year old woman of Japanese who was good health until May 1983, when she come to our hospital because of the visual disturbance. The chest X-ray film showed bilateral hilar lympha-denopathy and a transbronchial lung biopsy revealed sarcoid granuloma. She received systemic steroids (10 to 40 mg/2 days of predonisolone) for visual di-sturbance from August 1983 to May 1986. Then ste-roid therapy was suspended temporarily.

In August 1987, she was readmitted because of syn-copal episodes. She was noted to have irregular bradycardia and the electrocardiogram revealed atri-oventricular block and paroxysmal polymorphous ventricular tachycardia. Intially cardioversion to sinus rhythm was accumplished with direct current electric shock and temporary pacemaker was inserted and subsequently a permanent transvenous demandpacemaker implanted. The patient then became asymptomatic.

Coronary arteriography revealed no significant or-ganic stenosis and left ventriculogram showed a left ventricular aneurysm of the inferior wall of the left ventricle. A transvenous percutaneous right ven-tricular endomyocardial biopsy revealed non-specificmyocardial degeneration with slight interstitial fibro-sis. Thallium-201 myocardial perfusion scans re-vealed the inferior left ventricular defects. We con-clude the syncopal episodes and electrocardiographic abnormalities of this case were due to massive myo-cardial sarcoidosis which caused left ventricular an-urysm.