5 IN 1 MILLION - JASLOK HOSPITAL DEFYING THE ODDS IN TREATING RARE HEART DISEASE

The prevalence of Cardiac Sarcoidosis (CS) & Tuberculosis simultaneously in Asians is 5 in 1 million

Jaslok Hospital & Research Centre in Mumbai achieved a remarkable breakthrough in treating an extremely rare heart disease that occurs in only 5 in 1,000,000 people in Asia.

Mr. Raj Gorsa, a bank employee, experienced unusual symptoms such as chest pain, severe palpitations, and blackouts while working. On 10th November 2023 he was rushed to Jaslok Emergency Department. After a check-up and a series of tests, doctors identified that Raj had recurrent ventricular tachycardia, a potentially dangerous cardiac rhythm disorder. Despite initial attempts of treating him with medications, Raj's condition did not improve. As a result, the Cardiac team decided to perform an Automated Implantable Cardioverter Defibrillator (AICD) implantation.

On further investigations to diagnose, it was discovered that Tuberculosis (TB), which is a common respiratory problem and Cardiac Sarcoidosis which is a rare inflammatory illness that affects the heart muscle, were the combined causes of Raj's heart condition. Cardiac Sarcoidosis and Tuberculosis affecting the heart muscle can be a frequently missed diagnosis given its rarity and the high index of suspicion needed to make the diagnosis. The Multidisciplinary Team’s combined effort of advanced Imaging specialists, Electrophysiologists, Tnterventional Cardiologists & Intensivists is often required to arrive at the precise diagnosis and plan optimal treatment to achieve disease control and halt the progression. This Multidisciplinary Team at Jaslok Hospital was guided by Dr Ashwin Mehta (Director Cardiology ), and included Dr Rahul Chabbria ( Consultant Cardiology), Dr Upendra Bhalerao (Consultant Cardiovascular & Thoracic Surgery), Dr. Ameya Udayavar ( Consultant Electrophysiology) Dr Indraneel Raut (Addl. Director Critical Care Medicine) Dr Sadashiv Chaudhary (Consultant General, Bariatric & Laparoscopic Surgery) , Dr Rajashri Agaskar ( Consultant Cardiac Anaesthesia) , Dr Rushi Deshpande ( Director Nephrology- Academics ), Dr Vikarm Lele (Director Nuclear Medicine). Dr. Nimish Shah (Consultant Chest Medicine ) and Dr Mala Kaneria ( Consultant Infectious Diseases).

The Primary Cardiologist, Dr Rahul Chhabria mentioned “Myocardial tuberculosis is exceptionally rare forms of extra-pulmonary TB with few cases were reported worldwide. Sarcoidosis (CS) is multisystem granulomatous inflammatory disease with formation of noncaseating granulomas (lumps of proteins) of unknown aetiology. Sarcoidosis a rare heart disease that results from 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 combination of four anti TB drugs to achieve the disease control. Mr. Raj was started on steroids and Anti TB drug treatment” Mr. Raj continued to suffer from ventricular tachycardia and received multiple shocks from AICD to convert his heart rhythm to normal hence he was advised surgical options for controlling heart rate. He then underwent bilateral Thoracoscopic sympathectomy. This procedure involves cutting of the specific sympathetic nerves (the nerves that control the heart rate). The procedure was done in this patient using Thoracoscopic Minimally Invasive Techniques. This is rare surgery which is a last resort to control heart rate that is done for life threatening ventricular arrhythmias receiving AICD shocks. The surgery was high risk as he had persistently abnormal heart rate. The Multidisciplinary team that looked after Raj’s periprocedural care ensuring an uneventful recoveryraj was discharged hail and hearty on 27th November 2023.