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Kokyu to Junkan Volume 37, Issue 5 （May 1989）

呼吸と循環 37巻5号（1989年5月発行）

Japanese English

症例

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 外村洋一 ¹ , 吉村道博 ⁴ , 庄野元 ¹ , 内田英雄 ¹ , 木村義博 ¹ , 岳中耐夫 ² , 福田浩一郎 ² , 浜田哲夫 ³ , 志摩清 ² Yoichi Hokamura ¹ , Michihiro Yoshimura ⁴ , Hajime Shono ¹ , Hideo Uchida ¹ , Yoshihiro Kimura ¹ , Shinobu Takenaka ² , Koichirou Fukuda ² , Tetsuo Hamada ³ , Kiyoshi Shima ² ¹熊本市立熊本市民病院循環器科 ²熊本市立熊本市民病院呼吸器科 ³熊本市立熊本市民病院病理 ⁴熊本大学医学部循環器内科 ¹Division of Cardiology, Kumamoto Municipal Hospital ²Division of Respiratory, Kumamoto Municipal Hospital ³Division of Pathology, Kumamoto Municipal Hospital ⁴Division of Cardiology, Kumamoto University School of Medicine pp.547-552

発行日 1989年5月15日 Published Date 1989/5/15

DOI https://doi.org/10.11477/mf.1404205479

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Abstract 文献概要
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　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.