Fibrinolysis in STEMI - A Second thought
Abstract
Cardiac sarcoidosis (CS) is an infrequent element of systemic sarcoidosis, manifesting in upto 2% cases of sarcoidosis, but found in upto 25% of these on autopsy. Despite a plethora of tools such as ECG, echocardiography, cardiac MRI, PET scan, endomyocardial biopsy (EMB), accurate antemortem diagnosis of CS remains a challenge. Pathological hallmark of CS is a noncaseating epitheloid granuloma, either microscopic or macroscopic. It causes conduction defects manifesting on ECG as a variety of arrhythmias or non-specific ST-T segment changes. Uncommon amongst these is an ST segment elevation mimicking myocardial infarction (MI). This triggers an urge for fibrinolysis if a proper history and other confirmatory biochemical markers are not sought.
We report a previously healthy male presenting with chest discomfort and progressive breathlessness, and with ECG suggestive of ST segment elevation myocardial infarction (STEMI). Fibrinolytic therapy was spared owing to a high index of suspicion for CS against a background of detailed history and incoherent biochemistry. CS was confirmed by cardiac MRI and endomyocardial biopsy. Partial remission of symptoms was observed after steroid therapy along with antiarrhythmics.
References
2. Kim JS, Judson MA, Donnino R, Gold M, et al; Cardiac sarcoidosis. American Heart Journal. January 2009;157(1):9-21.
3. Iijima K, Chinushi M, Furushima H, Aizawa Y. Intramural inflammation as a cause of transient STsegment elevation in a patient of cardiac sarcoidosis. Europace 2012;14(2): 300-302.
4. Wang K, Asinger RW, Marriott HJL. ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction. N Engl J Med. 2003;349:2128-35.
5. Goldberger, Ary. Myocardial Infarction: Electrocardiographic Differential Diagnosis, 4th edition. Mosby-Year Book, 1991.
6. Deng JC, Baughman RP, Lynch JP. Cardiac Involvement in Sarcoidosis. Semin Respir Crit Care Med. 2002;23(6)
