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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 54-year-old woman had been treated under a diagnosis of cardiac sarcoidosis since 1998. She was admitted to our department because of recurrent heart failure in April 2002. A DDD pacemaker was implanted because of complete AV block in 2000, but she had always suffered from > or = New York Heart Association (NYHA) class III heart failure. To prevent recurrent heart failure, biventricular pacing was performed. The left ventricular epicardial pacing lead was newly inserted into the great cardiac vein via the left subclavian vein, and connected with the previously implanted generator. The QRS duration decreased from 200 to 140 msec. Serum brian natriuretic peptide level decreased from 321 to 226 pg/ml. Cardiac index increased from 1.93 to 2.20. Her functional class improved from NYHA class III to class II.
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PMID:[Beneficial biventricular pacing in a patient with cardiac sarcoidosis and refractory heart failure: a case report]. 1465 11

Cardiac involvement by sarcoidosis and concomitant deposition of AL amyloid is an uncommon association. We describe the case of a 53-year-old African-American man with a 7-year history of dilated nonischemic cardiomyopathy and severe cardiac failure who underwent orthotopic heart transplantation. His prior cardiac biopsies had only mild myocyte hypertrophy and minimal interstitial fibrosis. After surgery, numerous sarcoid granulomas and amyloid deposition were identified in the native heart. Six days after the transplant the patient died due to aspiration bronchopneumonia and acute renal failure. At autopsy, both sarcoidosis and immunoglobulin (Ig) lambda light-chain amyloidosis were present in the native atria, lungs, thyroid, liver, spleen, and kidneys. Sarcoid granulomas alone were present in the parathyroids, lymph nodes, and bone marrow. Amyloid deposition alone was present in the aorta, stomach, large bowel, and urinary bladder. There was no evidence of plasma cell dyscrasia, or underlying gammopathy. This unusual association was described in only two other cases in the medical literature. However, this is the first case of sarcoidosis and AL amyloidosis with successful sequencing and identification of Ig lambda light-chain amyloid, and in which there was no evidence of plasma cell dyscrasia.
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PMID:Sarcoidosis and immunoglobulin lambda II light-chain amyloidosis diagnosed after orthotopic heart transplantation: a case report and review of the literature. 1571 64

Cardiac sarcoidosis was diagnosed in 3 patients: 2 men aged 52 and 51 years, respectively, and a woman aged 55 years. Both men had ventricular tachycardia. In the first man, a right-ventricle biopsy revealed a non-caseating granuloma. The second man had active granulomatous cardiac infiltration, according to a gallium scintigram. The first man recovered after receiving immunosuppression, heart-failure medication, and an implantable defibrillator; the second received the same plus radio-frequency catheter ablation, but experienced serious heart failure. The woman was being treated for pulmonary sarcoidosis but complained of progressive cardiac symptoms. She recovered after receiving heart-failure medication, immunosuppression, and a biventricular pacemaker. Sarcoidosis is a multi-system granulomatous disorder of unknown aetiology with cardiac involvement in 20 to 30% of patients, resulting in severe morbidity and mortality. With the help ofgadolinium MRI and positron emission tomography (PET), these conditions can be detected at an earlier stage, which allows for improved evaluation of the efficacy of available therapies. The use of resynchronisation therapy and implantable defibrillators has improved the prognosis of patients with cardiac sarcoidosis.
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PMID:[Cardiac sarcoidosis: improved prognosis through new diagnostic tests and treatment]. 1612 71

A 64-year-old woman was transferred to the intensive care unit with dyspnea and palpitation on effort. Chest x-ray film showed cardiomegaly and pulmonary congestion. We carefully examined for sarcoidosis as a differential diagnosis of heart failure. Serum lysozyme was mildly high, but human atrial natriuretic peptide (HANP) and brain natriuretic peptide (BNP) were strikingly high. Angiotensin converting enzyme was within normal limit. Chest roentgenogram did not reveal bilateral hilar lymphadenopathy. Atrioventricular conduction block was not observed on electrocardiogram. Echocardiographic examination showed left ventricular global hypokinesis with septal thinning and enlargement. Mitral valve regurgitation was recognized by Doppler evaluation. Coronary arteriography showed normal coronary arteries. Endomyocardial biopsy revealed noncaseous epithelioid granulomas containing, Langhans type giant cell accompanied by fibrosis and lymphocyte infiltration. From these data cardiac sarcoidosis was diagnosed. Gallium scintigraphy showed diffuse uptake only in the heart. Treatment with oral prednisolone 20 mg/day was started. Her symptoms improved by several weeks after the medical treatment. In addition, both the value of HANP and BNP were markedly decreased and echocardiogram showed improvement of cardiac systolic function. In Japan, there is a higher incidence of cardiac sarcoidosis than in the West. The prognosis of this condition associated with cardiac dysfunction is reported to be very poor. When progressive heart failure in older patients is seen, cardiac sarcoidosis should also be kept in mind. Endomyocardial biopsy play an important role as the only accurate technique for the diagnosis of cardiac sarcoidosis.
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PMID:[A case of sarcoidosis in which sarocoid granulomas were observed only in the heart]. 1598 67

Myocarditis is a major cause of end-stage heart failure and is responsible for up to 10% of cases of idiopathic dilated cardiomyopathy (IDC). Worldwide, approximately 45% of all heart transplants are performed for IDC and up to 8% for myocarditis. Early reports suggested that survival after transplantation for myocarditis was poor and patients had an increased risk of rejection. More recently, larger case series suggest that overall survival after transplantation for myocarditis is similar to survival after transplantation for other causes. However, certain disorders, including cardiac sarcoidosis and giant cell myocarditis (GCM), require heightened surveillance for post-transplantation disease recurrence. We present the case of a 42-year-old man with recurrence of GCM 8 years after transplantation and review the literature on the role of cardiac transplantation for patients with myocarditis.
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PMID:Transplantation for myocarditis: a controversy revisited. 1610 47

This review may serve as a basis for evaluating publications on the topic "myocardial biopsy for myocarditis and dilated cardiomyopathy" in the clinical practice. The literature is particularly analyzed to answer the question, whether an endomyocardial catheter biopsy is indicated in patients with these myocardial disorders in the clinical routine besides its unequivocal scientific value. The judgment of the biopsy samples has been based on the classically histological and for years on the additional immunohistochemical and molecular biological-virological examination. The analysis of the literature data shows that outside scientific studies there is no indication to perform myocardial biopsy, or in other words, this procedure is not suitable for diagnosis, therapy, detection of early stages or prognostic evaluation in the disease spectrum "myocarditis, inflammatory heart disease, dilated cardiomyopathy". Reasons are the subjectivity in the judgment and interpretation of bioptic findings resulting in considerable interobserver variability, a missing standardization in biopsy performance, methods of examination and diagnostic criteria, the bioptic sampling error, missing therapeutic and prognostic consequences and potentially severe complications in performing myocardial biopsies. So far, the specificity of inflammatory changes in patients with dilated cardiomyopathy has not been proven in controlled blinded studies. The bioptic changes could be understood also as an unspecific inflammatory process in front of increasing pathophysiological evidence for myocardial inflammation in any form of heart failure. In addition, regarding the specific etiology of dilated cardiomyopathy, primarily a genetic, noninfectious or autoimmunologic origin plays an increasing role. The favorable clinical course and the very good prognosis of the acute, clinically diagnosed or supposed viral myocarditis should also be taken into account for the evaluation of myocardial biopsy. It should also be considered that the proof of causality between acute myocarditis and dilated cardiomyopathy is still lacking. Regarding the diagnosis "inflammatory cardiomyopathy" and multiple inflammatory subsets among patients with dilated cardiomyopathy or unclear regional contraction disorder, there is no adequate clinical validation of different diagnostic methods, criteria and interpretations so far. It is missleading to replace the well-established clinical diagnosis myocarditis by the bioptic diagnosis "inflammatory cardiomyopathy". However, endomyocardial catheter biopsy is clearly indicated in rare patients with fulminant myocarditis, giant-cell myocarditis and myocardial storage disease. Its probably underestimated role in sarcoid heart disease still needs to be clarified by systematic studies.
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PMID:[Indication for myocardial biopsy in myocarditis and dilated cardiomyopathy]. 1617 Jun 44

The group of restrictive cardiomyopathies (RKMP) includes a number of myocardial and endomyocardial diseases. These entities are characterized by stiffening of both ventricles resulting in a deterioration of ventricular filling and severe diastolic dysfunction. Systolic ventricular function is usually normal or only mildly impaired. Amyloidosis is the most prevalent underlying cause, but also sarcoidosis, hypereosinophilic syndrome with endocardial fibrosis and some inherited metabolic and storage diseases are common. Constrictive pericarditis is the main differential diagnosis, but noninvasive (magnetic resonance imaging, echocardiography, natriuretic peptides) and invasive diagnostic procedures allow separation of these two entities. Diagnosis of the underlying disease is mandatory for therapy of RKMP, as there are specific therapeutic options for symptom relief. Heart transplantation may be an option in end-stage heart failure.
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PMID:[Restrictive cardiomyopathy]. 1617 Jun 89

Cardiac sarcoidosis is a disease of young adults. In most cases it presents with sudden death, arrhythmias, conduction disorders, heart failure or cardiomyopathy. The authors describe two cases of myocardial involvement by sarcoidosis that lead to death of the patients. Case one was a 26-year-old Indian man who was previously well and presented with sudden death. Autopsy showed nodules of sarcoid granuloma involving the heart, lungs and lymph nodes. Case two was a 47-year-old Indian lady who complained of reduced effort tolerance. Echocardiography showed that she had restrictive hypertrophic cardiomyopathy with heart failure. Seven months after initial presentation, she developed worsening of heart failure and died. Autopsy revealed involvement of the heart, lungs and liver by sarcoidosis.
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PMID:Cardiac sarcoidosis: two cases with autopsy findings. 1619 53

We present the case of a young man who received a left ventricular assist device (LVAD) as a bridge to transplantation for end-stage heart failure, in whom the diagnosis of sarcoid cardiomyopathy was made at the time of LVAD implantation. He subsequently underwent uncomplicated heart transplantation. Nineteen months later, a routine surveillance endomyocardial biopsy specimen demonstrated recurrence of sarcoidosis in the transplanted heart.
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PMID:Recurrence of cardiac sarcoidosis in a heart transplant recipient. 1629 11

Cardiac sarcoidosis is a rare but important differential diagnosis in patients who present with progressive heart failure and arrhythmia. It may be diagnosed on endomyocardial biopsy. An excellent response can be achieved with steroid therapy in the early acute inflammatory stage. Progression of the disease may lead to end-stage heart failure that requires implantation of a permanent pacemaker, implantable cardioverter-defibrillator, or mechanical circulatory support as a bridge to heart transplantation. We present three Hong Kong Chinese patients with cardiac sarcoidosis.
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PMID:Cardiac sarcoidosis: a potentially fatal but treatable form of infiltrative heart disease. 1649 92


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