A case of cardiac sarcoidosis with concurrent myocardial ischemia

Rapoport, Eliot; Chidharla, Anusha; Mortoti, Samuel S.

doi:10.1016/j.hrcr.2021.04.005

Cited by 2 publications

(4 citation statements)

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“…PCI is widely regarded as the preferred therapeutic approach for most cases involving STEMI [ 50 ]. CABG is a major surgical operation reserved for cases not amenable to PCI [ 51 ]. While our study indicates decreased rates of CABG and PCI in sarcoidosis, there are few data specifically addressing STEMI treatment in sarcoidosis, so these findings could not be corroborated [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

“…CABG is a major surgical operation reserved for cases not amenable to PCI [ 51 ]. While our study indicates decreased rates of CABG and PCI in sarcoidosis, there are few data specifically addressing STEMI treatment in sarcoidosis, so these findings could not be corroborated [ 52 ]. Further research observing the type of coronary artery vessels, the number of arteries, and the type of lesions involved are needed to draw meaningful conclusions.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and clinical outcomes of patients with Sarcoidosis admitted for ST-elevation myocardial infarction in the United States: A propensity matched analysis from the National Inpatient Sample

Ahmed,

Najam,

Ramphul

et al. 2024

Arch Med Sci Atheroscler Dis

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IntroductionSarcoidosis is a systemic inflammatory disorder characterised by non-caseating granulomas. Cardiac sarcoidosis (CS) normally causes conduction abnormalities, ventricular arrhythmias, and heart failure. Little is known about the characteristics and impact of sarcoidosis in patients admitted with ST-elevation myocardial infarction (STEMI). This study aims to fill this void.Material and methodsUtilising the National Inpatient Sample (NIS) database (2016–2020), individuals with STEMI were identified and categorised based on sarcoidosis presence whilst adjusting for confounders via logistic regression models.ResultsAmong 851,290 STEMI patients, 1215 had sarcoidosis. Before propensity matching, sarcoidosis patients were notably different in demographics and comorbidities compared to non-sarcoidosis patients. After propensity score matching (PSM), sarcoidosis patients were found to have a higher incidence of supraventricular tachycardia (SVT) (2.5% vs. 1.3%, p = 0.024) and acute kidney injury (AKI) (23.3% vs. 20.8%, aOR = 1.269, 95% CI: 1.02–1.58, p = 0.033) but a lower incidence of undergoing coronary artery bypass graft (CABG) (5.5% vs. 8.5%, aOR = 0.663; 95% CI: 0.472–0.931, p = 0.018), while no significant disparities were noted in PCI, cardiogenic shock, mortality, or mean length of stay (LOS).ConclusionsUsing propensity-matched large real-world data of STEMI patients, sarcoidosis was associated with fewer cases of CABG and a greater incidence of AKI and SVT compared to non-sarcoidosis patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Characteristics and clinical outcomes of patients with Sarcoidosis admitted for ST-elevation myocardial infarction in the United States: A propensity matched analysis from the National Inpatient Sample

Ahmed,

Najam,

Ramphul

et al. 2024

Arch Med Sci Atheroscler Dis

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“…CS is clinically manifested in 5% of patients diagnosed with extracardiac sarcoidosis [ 1 , 2 ]. Clinical features of CS depend on the location, extent, and activity of the disease [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac sarcoidosis (CS) is clinically manifested in approximately 5% of patients with systemic sarcoidosis [ 1 , 2 ]. CS has a variable presentation including new-onset cardiomyopathy or conduction abnormalities [ 3 ], which presents as a diagnostic challenge because a definitive diagnosis with endomyocardial biopsy is often not feasible and diagnostic yield is typically low [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiac Sarcoidosis With Elevated Cardiac Troponin Mimicking Acute Myocardial Ischemia: A Case Report

Casipit¹,

Al-Sudani²,

Amanullah³

2023

Cureus

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Cardiac sarcoidosis (CS) is a disease entity with variable presentation causing significant morbidity and mortality. Concurrent signs of myocardial injury as evidenced by troponin elevation add to the complexity of an already challenging diagnosis. We present an unusual case of CS with elevated troponin I mimicking an acute ischemic cardiac event. A 48-year-old female presented with a two-month history of presyncope.  Electrocardiogram showed a bifascicular block with concomitant significant troponin I elevation. Two-dimensional echocardiography showed new-onset left ventricular systolic dysfunction with an ejection fraction of 40-45%. A heparin drip was initiated for possible non-ST-elevation myocardial infarction. Coronary angiography showed no evidence of epicardial coronary artery disease but did show an anomalous right coronary artery; however, CT angiography did not reveal any significant stenosis. Further, the telemetry monitor captured intermittent complete atrioventricular blocks. Due to concerns for an infiltrative cardiac disease, a cardiac magnetic resonance was done showing findings consistent with possible CS.  CT scan of the chest showed no radiographic evidence of pulmonary sarcoidosis. Fluorodeoxyglucose-positron emission tomography scan showed findings of active inflammation in the myocardium consistent with possible CS. The patient was treated for clinical CS with systemic corticosteroids and methotrexate. Follow-up six weeks later showed clinical improvement of symptoms. Our clinical case encompasses the unique variable presentation of CS including cardiac conduction abnormalities and left ventricular systolic dysfunction. Concomitant troponin I elevation can mimic myocardial ischemia, making the diagnosis more challenging. Treatment strategies aim to mitigate the long-term effects of CS on the heart; however, there is a paucity of data for appropriate pharmacological regimens.

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A case of cardiac sarcoidosis with concurrent myocardial ischemia

Cited by 2 publications

References 10 publications

Characteristics and clinical outcomes of patients with Sarcoidosis admitted for ST-elevation myocardial infarction in the United States: A propensity matched analysis from the National Inpatient Sample

Characteristics and clinical outcomes of patients with Sarcoidosis admitted for ST-elevation myocardial infarction in the United States: A propensity matched analysis from the National Inpatient Sample

Cardiac Sarcoidosis With Elevated Cardiac Troponin Mimicking Acute Myocardial Ischemia: A Case Report

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