Unusual Case of Tears in Heart Blood Vessels Found in Cardiac Sarcoidosis Patient

Tears in blood vessels of the heart can occur in people with cardiac sarcoidosis, a case report found, although the incidence of this complication appears to be low.

The report, “Spontaneous coronary artery dissection in cardiac sarcoidosis,” was published in Oxford Medical Case Reports.

Spontaneous coronary artery dissection (SCAD) is when a tear forms in the blood vessels of the heart. This can be life-threatening and, as such, requires prompt and appropriate medical treatment.

Cardiac sarcoidosis — sarcoidosis in which the heart is affected, either solely or as part of more systemic disease — is considered a risk factor for SCAD, but it is not clear how common SCAD is among people with cardiac sarcoidosis.

Researchers set out to estimate the prevalence of SCAD by analyzing data from registries of people with sarcoidosis in Finland and Canada.

Out of 481 patients with cardiac sarcoidosis with a median follow-up time of 3.7 years per patient (approximately 1,800 total patient-years), just one case of SCAD was identified.

That person, a 61-year-old female, was diagnosed with cardiac sarcoidosis in 2012 after arriving at a hospital with an abnormal heart rhythm. She was subsequently started on treatment with prednisone and methotrexate, and weaned from the latter medication over time. An implantable cardioverter defibrillator (ICD), a device that can help regulate heart rate, was placed in her heart.

In 2015, she arrived at a hospital with acute chest pain. A coronary angiogram (an X-ray of the heart and blood vessels) revealed lesions in heart arteries that were consistent with SCAD. The patient was restarted on methotrexate, the dosage of prednisone was increased (to 20 mg daily), and clopidogrel and aspirin were also prescribed.

A coronary angiogram several months later revealed that the lesions had resolved.

“Since the SCAD in November 2015, the patient has been stable with no arrhythmias, chest pain or heart failure exacerbations,” the researchers wrote.

Overall, this report suggests that SCAD in people with cardiac sarcoidosis is fairly unusual, with one case identified among 481 patients. Still, the researchers cautioned that “physicians should be aware that CS [cardiac sarcoidosis] can present with SCAD.”