Spontaneous coronary artery dissection in cardiac sarcoidosis

Abstract

Cardiac sarcoidosis (CS) is increasingly recognized as a cause of diverse cardiac manifestations. Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome especially among young females. The prevalence of sarcoidosis in the causal spectrum of SCAD has not been described before but sarcoidosis is cited as a potential yet rare cause of SCAD. We aimed to examine the frequency and characteristics of SCAD in CS. Searching two prospective CS registries with 481 CS patients, we found only one case of manifest SCAD. She is a 61-year-old female previously diagnosed with endomyocardial biopsy confirmed CS. She presented with chest pain and elevated troponin. Coronary angiogram revealed two-vessel SCAD. Fluorodeoxyglucose positron emission tomography scan showed likely reactivation of CS. The patient was treated with dual antiplatelet therapy and immunosuppression. Repeat angiogram showed complete resolution of the coronary lesions.

Cardiac Sarcoidosis Diagnostic Challenges and Management: A Case Report and Literature Review

“…Moreover, patients may show ECG abnormalities ranging from nonspecific ECG finding to conduction abnormalities and ventricular arrhythmias, which cannot sometimes be found in 12-lead ECG without Holter monitoring [ 21 ] as in Tan J et al case report ECG showed first-degree atrioventricular (AV) block and prolonged QT corrected for heart rate (QTc) interval while in Takamatsu et al 2017 case report ECG did not show any abnormality. Although sudden death due to cardiac sarcoidosis is not rare, some infrequent manifestations of CS are often overlooked or not properly diagnosed at times [ 22 - 24 ]. Cardiac magnetic resonance (CMR) could provide suggestive imaging of cardiac sarcoidosis, including diffuse hypokinesis and left ventricle dilatation, thinning of the interventricular septum, or regional wall abnormalities with a possible right ventricular akinesis or aneurysm [ 25 ].…”

“…2019 case report, the echo showed pericardial effusion pulmonary hypertension with a transvalvular pressure gradient of 40 mmHg. SCAD is likely still underdiagnosed due to misinterpreting results, but three cases have demonstrated the rarity of SCAD in CS [ 24 ]. Symptomatic pericardial involvement is rare, and few cases have been reported.…”

Cardiac Sarcoidosis Initially Diagnosed as Spontaneous Coronary Artery Dissection

“…Although the suspicion of coronary granulomatous vasculitis was not biopsy proven, this entity provides a more plausible explanation for the patient’s CAG findings than SCAD. If she did indeed have SCAD, then this is the first known antemortem report of a patient with previously undiagnosed CS who presented with SCAD; the only other antemortem case is that of a patient with an established CS diagnosis ( 6 ).…”

Spontaneous Coronary Artery Dissection Presenting As ST-Segment Elevation Myocardial Infarction

“…The association of sarcoidosis as a predisposing factor for SCAD is poorly understood. The proposed mechanism involves the breakdown of the tunica media-adventitia layer by inflammatory granulomas of cardiac sarcoidosis predisposing patients to SCAD [15]. Given that our patient was diagnosed with sarcoidosis seven years ago and has been in remission since then, it would be very unusual to have cardiac sarcoidosis presenting with SCAD without any other systemic manifestations.…”

“…The latter includes a progression of vessel wall tear, occlusion of branch vessels after stenting, in-stent restenosis, stent malposition, in-stent thrombosis, and stent migration [20]. However, if the patient continues to have ischemia or begins to have hemodynamic compromise, percutaneous or surgical revascularization should be considered [13][14][15][16][17][18][19][20][21]. The Canadian SCAD cohort study included 750 SCAD patients, yet only 2% required percutaneous coronary intervention, and 0.3% required CABG [22].…”