Cardiac sarcoidosis: Two case reports

Afriyie-Mensah, Jane S; Awindaogo, Felix; Tagoe, Emmanuella; Ayetey, Harold

doi:10.1002/ccr3.4270

Cited by 3 publications

(9 citation statements)

References 37 publications

(59 reference statements)

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“…Clinical features of CS depend on the location, extent, and activity of the disease [ 2 ]. Variations of the clinical manifestations include conduction abnormalities, ventricular arrhythmias, sudden death, or new-onset or worsening heart failure [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Conduction abnormalities are the most common manifestations of CS with a prevalence of about 62%. Complete heart blocks and bundle branch blocks are seen in about 23-30% and 12-32%, respectively [ 3 ]. This was evident in our case in which the patient developed intermittent complete heart block and an initial bifascicular block which involved an RBBB, which is usually more common in CS than a left bundle branch block [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cardiomyopathy, as evidenced by left ventricular dysfunction, is thought to be secondary to conduction abnormalities, extensive myocardial involvement, or both [ 3 ]. In our case, the presence of conduction abnormalities and infiltrative lesions seen on CMR could be the cause of left ventricular dysfunction.…”

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 ]. Concomitant troponin elevation, which may be seen in the active inflammatory phase of CS, may be mistaken for acute myocardial infarction (AMI).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Casipit¹,

Al-Sudani²,

Amanullah³

2023

Cureus

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“…Data on the disease burden of sarcoidosis in Ghana is not readily available. However, a number of cases have been reported such as that by Bajantri et al who reported on a 53-year-old woman with neurosarcoidosis [ 4 ] and two cases of cardiac sarcoidosis in a 51-year-old man and a 58-year-old woman reported by Afriyie-Mensah et al [ 5 ]. It is more common in females [ 1 ], and the age at diagnosis is usually between 40 and 55 years [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Exertional Dyspnea Incidentally Diagnosed as Sarcoidosis: A Teaching Hospital Experience

Nartey,

Ulzen-Appiah

2023

Case Reports in Pulmonology

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Background. Sarcoidosis is a complex disease with nonspecific etiology and clinical presentation. Its diagnosis is often delayed due to the absence of a single specific investigation modality. A multidisciplinary approach is necessary for its diagnosis. Report. A 49-year-old male presented with recurrent dyspnea on exertion, easy fatigue, and chest pain after several visits to different health facilities over 5 months. A diagnosis of pulmonary sarcoidosis was made after a series of laboratory and imaging investigations were done revealing bilateral reticonodular opacifications, noncaseating granulomata, elevated serum ACE and calcium levels consistent with sarcoidosis. Conclusion. Sarcoidosis, although a rare presentation in our setting, may easily be overlooked or misdiagnosed if a holistic or multidisciplinary approach is not employed in its diagnosis. Nonspecificity of symptoms contributes to the delayed diagnosis.

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Real-Life Utilization of Criteria Guidelines for Diagnosis of Cardiac Sarcoidosis (CS)

Gazitt

Kharouf

Feld

et al. 2023

JCM

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Despite the increasing recognition of cardiac involvement in systemic sarcoidosis, the diagnosis of cardiac sarcoidosis (CS) remains challenging. Our aim is to present a comprehensive, retrospective case series of CS patients, focusing on the current diagnostic guidelines and management of this life-threatening condition. In our case series, patient data were collected retrospectively, including hospital admission records and rheumatology and cardiology clinic visit notes, detailing demographic, clinical, laboratory, pathology, and imaging studies, as well as cardiac devices and prescribed medications. Cases were divided into definite and probable CS based on the 2014 Heart Rhythm Society guidelines as well as presumed CS based on imaging criteria and clinical findings. Overall, 19 CS patients were included, 17 of whom were diagnosed with probable or presumed CS based on cardiac magnetic resonance imaging (CMR) and/or cardiac positron emission tomography using 18F-Fluorodeoxyglucose (PET-FDG) without supporting endomyocardial biopsy (EMB). The majority of CS patients were male (53%), with a mean age of 52.9 ± 11.8, with CS being the initial manifestation of sarcoidosis in 63% of cases. Most patients presented with high-grade AVB (63%), followed by heart failure (42%) and ventricular tachyarrhythmia (VT) (26%). This case series highlights the significance of utilizing updated diagnostic criteria relying on CMR and PET-FDG given that cardiac involvement can be the initial manifestation of systemic sarcoidosis, requiring prompt diagnosis and treatment to prevent morbidity and mortality.

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Cardiac sarcoidosis: Two case reports

Cited by 3 publications

References 37 publications

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

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

Exertional Dyspnea Incidentally Diagnosed as Sarcoidosis: A Teaching Hospital Experience

Real-Life Utilization of Criteria Guidelines for Diagnosis of Cardiac Sarcoidosis (CS)

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