Mumbai, Feb 15 A team of doctors here achieved a remarkable breakthrough in treating a 35-year-old man with an extremely rare heart disease that occurs in only 5 in 1,000,000 people in Asia.
The patient, Raj Gorsa, a bank employee, was brought to Jaslok Hospital & Research Centre in Mumbai after experiencing unusual symptoms such as chest pain, severe palpitations, and blackouts while working on November 10, last year.
After a series of tests, doctors identified that Raj had recurrent ventricular tachycardia -- a potentially dangerous cardiac rhythm disorder.
As initial attempts with medications did not improve Raj's condition, the doctors resorted to automated implantable cardioverter defibrillator (AICD) implantation.
Further investigations by cardiac MRI and PET scan and biopsy of his neck node revealed he suffered from a combination of cardiac tuberculosis (TB) -- a common respiratory problem that rarely affects the heart -- and cardiac sarcoidosis -- a rare inflammatory illness that affects the heart muscle.
The patient did not have any previous history of tuberculosis. In a hospital statement, the doctors stated that the prevalence of cardiac sarcoidosis and tuberculosis simultaneously in Asians is five in one million cases.
They noted that the condition can be a frequently missed diagnosis given its rarity and the high index of suspicion needed to make the diagnosis.
"Myocardial tuberculosis is an exceptionally rare form of extra-pulmonary TB with few cases reported world-wide. Sarcoidosis (CS) is a multisystem granulomatous inflammatory disease with formation of non-caseating granulomas (lumps of proteins) of unknown aetiology," said Dr Rahul Chhabria, the Primary Cardiologist, in the statement.
"Sarcoidosis is a rare heart disease that results from the immune system to overreact causing lumps of tissues (granulomas) in the heart muscle. Primary treatment for cardiac sarcoidosis is immunosuppression with corticosteroids with the goal of reducing inflammation and fibrosis, thereby preventing disease progression. Tuberculous Myocarditis is treated with a combination of four anti-TB drugs to achieve disease control. Raj was started on steroids and anti-TB drug treatment," the doctor explained.
Raj continued to suffer from ventricular tachycardia and received multiple shocks from AICD to convert his heart rhythm to normal. He was then treated using bilateral Thoracoscopic sympathectomy, a rare surgical procedure that involves cutting of the specific sympathetic nerves (the nerves that control the heart rate).
The procedure was done using thoracoscopic minimally invasive techniques.
The surgery was high risk as he had a persistently abnormal heart rate.
The multidisciplinary team that looked after Raj's periprocedural care and ensured an uneventful recovery.
Raj was discharged hale and hearty on November 27.
The doctors monitored his heart condition for 6 weeks to ensure that there are no heart rhythm disturbances affecting his daily life, the statement said.
"I am happy to be alive and recovering now. My heart disease had turned my life upside down, and there were several touch-and-go moments when I would receive shocks to get my heart back in action," said Raj, expressing his gratitude to doctors.
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