Acute Heart Failure Secondary to Isolated Cardiac Sarcoidosis
Cardiac sarcoidosis is a potentially fatal condition that may precede, follow or occur concurrently with involvement of other organs. Delay in diagnosis may uncommonly lead to presentation with acute decompensated congestive heart failure.
A 53 year-old female presented with dyspnea, chest tightness and orthopnea that had been slowly progressing over 2 years. Prior evaluation 2 years ago had included normal coronaries with normal ejection fraction and a normal CT chest. EKG showed sinus rhythm with normal intervals. Echocardiogram this admission now revealed severely dilated cardiomyopathy with ejection fraction of 9%. Repeat catheterization again revealed normal coronaries. Evaluation of her non-ischemic cardiomyopathy included normal ferritin, TSH, serum protein, ESR and negative HIV, HBV and HCV. Further work up with PET scan found inflammation of mediastinal lymph nodes and heart presumed to be secondary to sarcoidosis. She underwent VATS-guided mediastinal lymph node biopsy and pathology showed non-caseating granulomas consistent with sarcoidosis. She was pulsed with intravenous steroids and continues on prednisone taper with a good response. Follow up PET scan in 2 months showed dramatic reduction in cardiac inflammation and repeat echocardiogram at 3 months revealed ejection fraction 23%.
Cardiac sarcoidosis can present as arrhythmias, heart failure or sudden cardiac death. Advanced imaging with MRI and PET scan may be helpful in unexplained cardiomyopathy or arrhythmias.
Annual ACP Regional Meeting
Rajagopalan, P., & Donato, A. A. (2016). Acute Heart Failure Secondary to Isolated Cardiac Sarcoidosis. Annual ACP Regional Meeting Retrieved from https://scholarcommons.towerhealth.org/gme_int_med_resident_program_read/227