• J Schwock, H Thiele, and Ch Wittekind.
• Institut für Pathologie, Universitätsklinikum Leipzig, Germany. schjo@medizin.uni-leipzig.de
• Dtsch. Med. Wochenschr. 2003 Jan 3; 128 (1-2): 26-30.

Clinical PresentationA 55-year-old woman required emergency medical care because of sudden weakness. On arrival of the emergency physician the patient presented with bradycardia with a normal rhythm. The blood pressure was not measurable. The patient complained of recurrent dizziness for a few months. Subsequently, the patient presented with an asystole and required reanimation and insertion of a temporary cardiac pacemaker. On admission at the hospital myocardial infarction was suspected.Clinical And Laboratory TestsAt the time of admission the patient presented in cardiogenic shock. The ECG revealed a 3rd atrioventricular block with idioventricular rhythm. Echocardiography showed reduced left ventricular function with global hypokinesia of the myocardium. Coronary artery disease was excluded by angiography. To exclude acute pulmonary embolism a CT-scan of the thorax was performed, revealing enlarged lymph nodes in the mediastinum.Treatment And Response To TherapyDespite the administration of high-dose catecholamines and before a left atrial-to-femoral arterial assist device could be completely implanted the patient died of cardiogenic shock.AutopsyAutopsy revealed non-caseating epitheloid granulomas in the enlarged mediastinal lymph nodes as well as in the lung parenchyma, myocardium and several other organs.ConclusionThe cardiac involvement of previously undiagnosed systemic sarcoidosis was the cause of sudden death. In case of ECG changes of unknown cause in persons without a history of structural cardiac disease sarcoidosis should be considered in the differential diagnosis.

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