Schmidt, Tyler J

A 104-year-old woman presented with dyspnoea. Workup revealed normal troponins, elevated D-dimer at 2285 with subsequent chest CT angiogram negative for pulmonary embolism. NT-pro BNP elevated to 5208 pg/mL. Chest X-ray revealed mild cardiac enlargement with bilateral pleural effusions. ECG revealed accelerated junctional rhythm. The initial plan was to obtain transthoracic echocardiogram and start diuresis for presumed heart failure. Given her specific cardiac history, pacemaker interrogation was ordered which revealed her pacemaker mode changed from DDDR to VVI. She underwent pacemaker battery exchange with complete resolution in her symptoms and ability to return to prior functional status. Overall, dyspnoea in centenarians could be multifactorial. Pacemaker elective replacement mode secondary to end of life battery can present as non-specific cardio respiratory symptoms. As the pacemaker population ages to the survival beyond the battery life, pacemaker aetiology behind heart failure symptoms needs to be highly considered by medical providers.

To our knowledge, natural history has not been reported for cardiac sarcoidosis (CS) diagnosed by pathologic evaluation of the apical core at left ventricular assist device (LVAD) implantation or cardiac transplantation. We retrospectively identified 232 consecutive patients meeting CS criteria. Of these patients, 54 were diagnosed by pathologic confirmation of CS, 10 after evaluation of the apical core (LVAD implant) or explanted heart (transplant). We compared clinical characteristics at initial evaluation and outcomes for these 10 patients with those of 10 patients with known CS before LVAD implant/transplant. In the study group, five patients (50%) had confirmed extracardiac sarcoidosis before LVAD implant/transplant; five had not been diagnosed with sarcoidosis. Mean (standard deviation) left ventricular ejection fraction at initial evaluation was 23% (16%), and left ventricular end-diastolic dimension was 61 (10) mm. Four patients died during follow-up; however, no survival difference was found for the 10 patients diagnosed incidentally and the group with a previous diagnosis or institutional LVAD/transplant cohorts. Patients diagnosed with CS on pathological examination of the apical core/explanted heart may have severe dilated cardiomyopathy as the initial presentation. Outcomes for patients with CS after advanced heart failure therapies may be comparable with those of non-CS patients.