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Does sarcoidosis cause right bundle branch block?

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Posted on Mon, 25 Jul 2016
Question: 3 years ago I was diagnosed with an incomplete rbb qrs .114 and marked left axis deviation due to a lafb. Although this is not a true Bifasicular Block 2 of my fasicles appear to have been damaged. I was and still am totally asymptomatic regarding any cardiac symptoms. I had a stress test and echo performed by a cardiologist and both of those test were normal. The cardiologist said it was benign and likely a congenital defect and no further action was required. he advised me to come back when I turned 40 for routine cardiology work up as I am at risk for dying if I have a heart attack. my ekg over the last 2 years have remained the same with no changes which is good. back in September I was diagnosed with sarcoidosis. I did some research and found that sarcoidosis can cause heart defects especially conduction abnormalities. I am very concerned now that my conduction issues may be related to the sarcoidosis. if 3 years have past and no changes in the ekg could this be sarcoidosis or just a random coincedence?
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Answered by Dr. Meriton Siqeca (2 hours later)
Brief Answer:
Nothing to be worried about at the moment

Detailed Answer:
Greetings and welcome to HCM, thank you for your question. I understand your concern.

Yes, it is true that sarcoid disease would cause conduction abnormalities, but I do not think that this is the case. Your conduction abnormalities point more towards a congenital happening, which can be found up to 16% of the totally normal population of the world. If this is the case, it only should be monitored periodically through EKGs, to capture the moment when the conduction system is "getting old" and/or when symptoms, such as fainting or dizziness have started. And I am referring to the age of at least above 60 years old.

Sarcoidosis is a systemic condition which is accompanied with granulomatous formulations deposited within parenchyma (tissue) of some organs, it also may be deposited within the heart muscle. The more often than conduction abnormalities are cardiac arrhythmias. This condition has only some vague, non-specific changes in the EKG. The more specific exam that shows sarcoidosis of the heart (it is only when it os detected when cardiac arrhythmias and conduction abnormalities may be expected) is the echo cardiogram, which, in your case, did not show these granulomatous formations. Therefore, you have nothing to be worried about, at the moment, as your incomplete right bundle branch block combined with left anterior fascicular block, is not coming from your sarcoid disease. This is my opinion. However, I would recommend you to perform echo cardiogram on yearly bases. Even if it affects the heart, there are assist devices that do not treat sarcoid disease, but prevent sudden cardiac death.

I hope I was helpful with my answer. I am happy to help, if you have follow-up questions.

Kind regards,
Dr. Meriton
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Meriton Siqeca (1 hour later)
thank you for the response. my doctor is not concerned either but I did ask him if he could try and get approval for me to have a cardiac mri. he said though with the incomplete rbbb and left axis deviation and no symptoms the likely hood of positive test would be extremely low and possibly inconclusive and the insurance may not authorize the test.
doctor
Answered by Dr. Meriton Siqeca (6 hours later)
Brief Answer:
Not needed

Detailed Answer:
Hi again and welcome back.

Well, I would not recommend this exam right now, since there ar no symptoms nor there are evidence in the echo cardiogram. After all, it is an exam that shoul be done based on a clear-cut indication, not on the patient's free will - I think that is why the insurance would not cover for it.

I hope my follow-up is helpful.

If you do not have further questions, kindly close the discussion and rate the answer.

Regards,
Dr. Meriton
Above answer was peer-reviewed by : Dr. Priyanka G Raj
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Dr. Meriton Siqeca

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Practicing since :2009

Answered : 773 Questions

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Does sarcoidosis cause right bundle branch block?

Brief Answer: Nothing to be worried about at the moment Detailed Answer: Greetings and welcome to HCM, thank you for your question. I understand your concern. Yes, it is true that sarcoid disease would cause conduction abnormalities, but I do not think that this is the case. Your conduction abnormalities point more towards a congenital happening, which can be found up to 16% of the totally normal population of the world. If this is the case, it only should be monitored periodically through EKGs, to capture the moment when the conduction system is "getting old" and/or when symptoms, such as fainting or dizziness have started. And I am referring to the age of at least above 60 years old. Sarcoidosis is a systemic condition which is accompanied with granulomatous formulations deposited within parenchyma (tissue) of some organs, it also may be deposited within the heart muscle. The more often than conduction abnormalities are cardiac arrhythmias. This condition has only some vague, non-specific changes in the EKG. The more specific exam that shows sarcoidosis of the heart (it is only when it os detected when cardiac arrhythmias and conduction abnormalities may be expected) is the echo cardiogram, which, in your case, did not show these granulomatous formations. Therefore, you have nothing to be worried about, at the moment, as your incomplete right bundle branch block combined with left anterior fascicular block, is not coming from your sarcoid disease. This is my opinion. However, I would recommend you to perform echo cardiogram on yearly bases. Even if it affects the heart, there are assist devices that do not treat sarcoid disease, but prevent sudden cardiac death. I hope I was helpful with my answer. I am happy to help, if you have follow-up questions. Kind regards, Dr. Meriton