Cardiac Sarcoidosis Initially Diagnosed as Spontaneous Coronary Artery Dissection
Hadil Zureigat1, Rachel Frank2, Viral S Shah3
1Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
JACC. Case Reports
|November 12, 2021
Insights
A woman experienced spontaneous coronary artery dissection and later developed atrioventricular block, revealing cardiac sarcoidosis. This rare case highlights challenges in diagnosing cardiac sarcoidosis.
Area of Science:
- Cardiology
- Immunology
- Pathology
Background:
- Cardiac sarcoidosis is an inflammatory condition affecting the heart.
- Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction.
- Atrioventricular block can be a manifestation of cardiac involvement in sarcoidosis.
Observation:
- A patient presented with presumed spontaneous coronary artery dissection of a septal branch.
- The patient subsequently developed high-grade atrioventricular block.
- Diagnostic workup revealed cardiac sarcoidosis involving the interventricular septum.
Findings:
- This case demonstrates a rare association between SCAD and cardiac sarcoidosis.
- The interventricular septum was identified as the site of cardiac sarcoidosis.
- High-grade atrioventricular block was a key indicator of cardiac involvement.
Implications:
- This case underscores the importance of considering cardiac sarcoidosis in patients with unexplained heart block and coronary abnormalities.
- Early diagnosis and management of cardiac sarcoidosis are crucial to prevent adverse cardiac events.
- Further research is needed to elucidate the pathophysiology linking SCAD and cardiac sarcoidosis.
Abstract:
We present the case of a woman who developed presumed spontaneous coronary artery dissection of a septal branch. She later developed high-grade atrioventricular block that led to a diagnosis of cardiac sarcoidosis involving the interventricular septum. This case illustrates a rare and challenging presentation of cardiac sarcoidosis. (Level of Difficulty: Beginner.).
Keywords:
AVB, atrioventricular blockCAD, coronary artery diseaseCAG, coronary angiographyCS, cardiac sarcoidosisCT, computed tomographyECG, electrocardiogramFDG, 18F-fluorodeoxyglucoseIVS, interventricular septumPET, positron emission tomographySCAD, spontaneous coronary artery dissectionTTE, transthoracic echocardiogrambradycardiacardiomyopathyimagingpalpitations
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