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Published on: June 16, 2020
Cardiac sarcoidosis presenting as constrictive pericarditis
Saba Darda1, Marcel E Zughaib1, Patrick B Alexander1
1Department of Cardiology, Providence Hospital and Medical Center, South-field, Michigan 48075.
Insights
Cardiac sarcoidosis, a rare cause of constrictive pericarditis, was diagnosed in a patient presenting with heart failure. Early detection and management of this condition are crucial for patient outcomes.
Area of Science:
- Cardiology
- Pathology
- Immunology
Background:
- Cardiac sarcoidosis commonly affects the myocardium and endocardium, leading to heart failure, arrhythmias, and conduction disturbances.
- Constrictive pericarditis is an infrequent manifestation of sarcoidosis, with limited documented cases.
Observation:
- A 57-year-old male presented with symptoms and hemodynamic findings suggestive of constrictive pericarditis of unknown etiology.
- The patient experienced recurrent pleural effusion and underwent pericardiectomy following a complex hospital stay.
Findings:
- Post-pericardiectomy, the patient showed significant clinical and hemodynamic improvement.
- Pathologic findings, clinical course, and treatment response confirmed cardiac sarcoidosis presenting as constrictive pericarditis.
Implications:
- This case highlights the importance of considering cardiac sarcoidosis in the differential diagnosis of constrictive pericarditis.
- Increased awareness and early diagnosis of cardiac sarcoidosis are essential for effective management and potentially curative treatment.
Abstract:
In patients with cardiac sarcoidosis, the sarcoid granulomas usually involve the myocardium or endocardium. The disease typically presents as heart failure with ventricular arrhythmias, conduction disturbances, or both. Constrictive pericarditis has rarely been described in patients with sarcoidosis: we found only 2 reports of this association. We report the case of a 57-year-old man who presented with clinical and hemodynamic features of constrictive pericarditis, of unclear cause. He was admitted for treatment of recurrent pleural effusion. After a complicated hospital course, he underwent pericardiectomy. His clinical and hemodynamic conditions improved substantially, and he was discharged from the hospital in good condition. The pathologic findings, the patient's clinical course, and his response to pericardiectomy led to our diagnosis of cardiac sarcoidosis presenting as constrictive pericarditis. In addition to the patient's case, we discuss the nature and diagnostic challenges of cardiac sarcoidosis. Increased awareness of this disease is necessary for its early detection, appropriate management, and potential cure.
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