Working Diagnosis:
Cardiac sarcoidosis and dilated cardiomyopathy
Treatment:
A subcutaneous Automatic Implantable Cardioverter Defibrillator (AICD) was placed due to ventricular fibrillation for secondary prevention. Case Photo #6 Case Photo #7 He was discharged on new medications, including: Sacubitril-Valsartan twice daily, Eplerenone twice daily, Metoprolol Succinate once daily. He was also discharged to cardiac rehabilitation.
Outcome:
Favorable. Patient was recently cleared to ride his road bicycle and run at 45 minutes of moderate intensity, each.
Author's Comments:
This athlete, although he can no longer compete, is a major advocate for cardiac sarcoidosis awareness. He even returned to the same track event the following year to fire the starting gun for the race he sustained cardiac arrest during.
Editor's Comments:
Exercise associated sudden cardiac death is fortunately a very rare event. Those affected can be young and appear quite healthy. Most events with an identifiable cause have been found to involve a structural heart condition (hypertrophic cardiomyopathy being the most common), which predisposes the individual malignant arrhythmias.
References:
Mankad, P., Mitchell, B., Birnie, D. et al. Cardiac Sarcoidosis. Curr Cardiol Rep 21, 152 (2019). https://doi.org/10.1007/s11886-019-1238-1
Doughan, A.R., Williams, B.R. Cardiac Sarcoidosis. Heart 92, 282-288 (2006). https://doi.org/10.1136/hrt.2005.080481
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