Abstract 12732: Cardiac Sarcoidosis With Elevated Cardiac Troponin Mimicking Acute Myocardial Ischemia

Abstract

Background Cardiac Sarcoidosis (CS) is a disease with variable presentation causing significant morbidity and mortality. Concurrent signs of myocardial injury as evidenced by troponin elevation add to the complexity of an already challenging diagnosis. Case A 48-year-old female with no significant past medical history presented with episodes of presyncope for 2 months. ECG showed a bifascicular block. Troponin I was elevated to 7.29 ng/mL. 2D echo showed Left Ventricular (LV) systolic dysfunction with an LVEF of 40%. Heparin drip was initiated for a possible NSTEMI. Coronary angiography showed no evidence of epicardial coronary artery disease but showed an anomalous right coronary artery which on CT angiogram later showed no hemodynamically significant stenosis. Telemetry monitoring captured intermittent complete atrioventricular blocks. A biventricular implantable cardioverter-defibrillator was inserted. Due to concerns for infiltrative cardiac disease, a cardiac magnetic resonance (CMR) was done showing findings consistent with cardiac sarcoidosis (CS). CT scan of the chest showed radiographic evidence of pulmonary sarcoidosis, however, she declined further invasive workup. She was then started on systemic corticosteroids. 2D echo 6 months later revealed improvement in the LVEF to 55%. Discussion Our case encompasses the variable presentation of CS including cardiac conduction abnormalities and LV systolic dysfunction. Concomitant troponin elevation in CS can mimic myocardial ischemia making the diagnosis more challenging. This highlights the importance of appropriate diagnostic acumen in approaching a case like this. Current guidelines now include non-invasive means for diagnosis including the use of CMR/PET CT, especially since endomyocardial biopsy has a low sensitivity. Treatment strategies aim to mitigate the long-term effects of CS on the heart, however, there is a paucity of data for appropriate pharmacological regimen.