Chasing the ACE of hearts.

Area of Science:

• Cardiology
• Immunology
• Pathology

Background:

• Sarcoidosis is a multisystem inflammatory disease characterized by non-caseating granulomas.
• Cardiac involvement in sarcoidosis can present with diverse and sometimes subtle clinical manifestations.
• Distinguishing cardiac sarcoidosis from other causes of heart failure and myocardial injury is clinically challenging.

Observation:

• A patient presented with acute pulmonary edema, dynamic electrocardiogram (ECG) changes, and elevated cardiac biomarkers, initially without evidence of myocardial infarction.
• The patient's clinical course indicated a dynamic and inflammatory disease process.
• Tissue histology confirmed the presence of sarcoidosis.

Findings:

• The patient exhibited symptoms mimicking acute coronary syndrome but was diagnosed with cardiac sarcoidosis.
• Treatment with corticosteroids resulted in an excellent clinical response.
• Cardiac magnetic resonance imaging (MRI) at six months revealed minimal myocardial hyperenhancement, suggesting limited focal fibrosis.

Implications:

• This case underscores the diagnostic challenges of sarcoidosis when cardiac and lymphatic systems are primarily involved.
• Early recognition and treatment of cardiac sarcoidosis are crucial for favorable outcomes.
• The findings emphasize the utility of corticosteroid therapy in managing cardiac sarcoidosis and preventing extensive myocardial damage.