A Change of Heart
Cardiac sarcoidosis can present as ventricular ectopy, sustained ventricular arrhythmias, asymptomatic ventricular dysfunction, heart failure, or sudden death. Although 25% of patients with sarcoidosis have evidence of cardiac involvement autopsy, only 5% have clinical manifestations. In the case study discussed in this chapter, while the original diagnostic findings were accurate and strongly suggested arrhythmogenic right ventricular dysplasia (ARVD), a change of heart was needed to arrive at the ultimate diagnosis. Cardiomyopathy in a young person requires consideration of a broad differential diagnosis that is distinct from the most common etiologies of cardiomyopathy in the elderly. Anchoring bias is a common pitfall in clinical decision making. When new or contradictory findings are uncovered, clinicians should reevaluate their initial impression to ensure it remains the most likely diagnosis. The differential diagnosis of ARVD includes idiopathic ventricular tachycardia, right ventricular outflow tract tachycardia, myocarditis, idiopathic dilated cardiomyopathy, and sarcoidosis. © 2013 Wiley-Blackwell..
Piccini, JP; Hernandez, AF; Dibernardo, LR; Rogers, JG; Dhaliwal, G
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