16. A Change of Heart

  1. James C. Pile5,
  2. Thomas E. Baudendistel6 and
  3. Brian J. Harte7
  1. Jonathan P. Piccini1,
  2. Adrian F. Hernandez1,
  3. Louis R. Dibernardo2,
  4. Joseph G. Rogers1 and
  5. Gurpreet Dhaliwal3,4

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch16

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Piccini, J. P., Hernandez, A. F., Dibernardo, L. R., Rogers, J. G. and Dhaliwal, G. (2013) A Change of Heart, in Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine (eds J. C. Pile, T. E. Baudendistel and B. J. Harte), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118483206.ch16

Editor Information

  1. 5

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

  2. 6

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

  3. 7

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Author Information

  1. 1

    Division of Cardiovascular Medicine, Duke Clinical Research Institute, Duke University Medical Center, Duke University, Durham, North Carolina, USA

  2. 2

    Department of Pathology, Duke University Medical Center, Duke University, Durham, North Carolina, USA

  3. 3

    Department of Medicine, University of California, San Francisco, California, USA

  4. 4

    Medical Service, San Francisco VA Medical Center, San Francisco, California, USA

Publication History

  1. Published Online: 21 MAR 2013
  2. Published Print: 15 MAR 2013

Book Series:

  1. Hospital Medicine: Current Concepts

Book Series Editors:

  1. Scott A. Flanders and
  2. Sanjay Saint

ISBN Information

Print ISBN: 9780470905654

Online ISBN: 9781118483206

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Keywords:

  • arrhythmogenic right ventricular dysplasia (ARVD);
  • cardiac sarcoidosis;
  • cardiomyopathy;
  • change of heart;
  • clinical decision making;
  • myocarditis;
  • tachycardia

Summary

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.