Sarcoidosis is a granulomatous disease histologically characterized by non-caseating granulomas. Although it usually affects the lungs, it can affect any organ system and present with a wide variety of symptoms. Heerfordt-Waldenström Syndrome, or uveoparotid fever, is a rare form of sarcoidosis that presents with a combination of fever, parotitis, facial paralysis, and uveitis. In this case report, we demonstrate a rare manifestation of sarcoidosis in a patient who presents with both the aforementioned syndrome and cardiac involvement. This case serves to highlight the importance of identifying the various clinical manifestations and management of systemic sarcoidosis.
Wellen's syndrome is a pattern on ECG that signifies impending acute myocardial infarction (MI) of the proximal left anterior descending (LAD) artery. This same pattern can also be noted in several benign diseases that may mimic Wellen's syndrome. Here we discuss a 36-year-old patient with no cardiac risk factors who presented with typical angina shortly after smoking marijuana. Upon arrival to the ED, an electrocardiogram revealed new biphasic T wave inversions in the anterolateral leads and cardiac biomarkers were found to be elevated. The patient was taken for emergent coronary angiography which revealed widely patent coronary arteries. Soon after, the patient was diagnosed with Pseudo-Wellen's syndrome secondary to cannabis use. This case report highlights the importance of identifying causes that may resemble Wellen's syndrome, especially in young adults without risk factors for acute coronary syndrome (ACS). Recognizing these cases can help avoid further invasive diagnostic testing, along with the complications that may go along with it.
The cardiac implications of Covid-19 are variable. Here we describe a gentleman with Covid-19 induced myocarditis with resultant atrial fibrillation. CASE PRESENTATION: A 39 year-old male with no past medical history presented to the hospital with fevers and lower extremity swelling that started 7 days prior. In the ED an EKG revealed new-onset atrial fibrillation with RVR, while a TTE showed newly reduced EF of 10%. An infectious workup was conducted and positive for Covid-19. Inflammatory markers including ESR and CRP were found to be significantly elevated, along with mildly elevated troponin T which remained flat. Other etiologies of heart failure such as valvular disease, thyroid disorders, etc. were ruled out. Coronary angiography was deferred as suspicion for ACS remained low. It was noted that the patient's heart rate began to normalize as the fevers improved and the markers of inflammation decreased. Cardiac MRI was performed which revealed late gadolinium enhancement involving the subepicardium, consistent with myocardial injury and a diagnosis of myocarditis. Prior to discharge, the patient converted to normal sinus rhythm and repeat bedside echocardiogram suggested moderate improvement in ejection fraction. Patient was discharged medically stable with a repeat TTE scheduled to be performed in three months.
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