A patient with atrioventricular block and ventricular tachycardia: think sarcoid!

Cardiac involvement in sarcoidosis is often difficult to diagnose, and most alarmingly can lead to sudden cardiac arrest as its first manifestation. We report the case of a 45-year-old Indian woman with an implanted permanent pacemaker for atrioventricular block, who presented with haemodynamically stable ventricular tachycardia and was found to have impaired left ventricular function. Subsequent investigations established the diagnosis of cardiac sarcoidosis. The patient was treated with prednisolone initially at 40 mg a day for 3 months.

Nodular thyroid disease

Nodular thyroid disease is common. Ultrasound examination of the neck for a variety of reasons has revealed a linear increase in the prevalence of thyroid nodules from negligible at 15 years to 50% by the age of 60. Only 10% of these nodules are palpable by experienced examiners. Conversely, 50% of patients referred to a thyroid clinic with an apparently solitary thyroid nodule will be found to have a multinodular goitre.